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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.
The last decade has witnessed striking progress in assisted reproductive technology (ART) and over the past few years the success rate of ART has increased significantly due to the introduction of novcl technologies and improved embryo culture systems. Along with this rapid pace of development comes the need for clinicians to keep abreast.
This book brings fresh insights into the pathophysiology of human reproduction, providing up-to-date and practical information on the clinical and laboratory management of subfertility. Particular emphasis is placed on the clinical appraisal of the current and potential strategies to improve the management of the subfertile couple, as well as the various therapeutic options available for the management of subfertility.
The preparation of this book was driven by a desire to provide a hands-on, practical guide to assisted reproduction that would be accessible to those practising in the field of Assisted Reproduction, those working on the establishment and day-to-day running of an IVF clinic, and those with a more general interest in assisted reproduction. The contributing authors include internationally renowned clinicians and scientists actively involved in the field of reproductive medicine and those who are acknowledged in their own fields.
We are most grateful to all who have made the publication of this book possible.
To women traditionally considered irreversibly sterile due to ovarian failure, oocyte donation and exogenous steroid replacement offers the prospect of achieving a successful pregnancy. Women requiring oocyte donation comprise two main groups: women with primary or secondary ovarian failure, and women with normal menstrual cycles. There will always be an imbalance between supply of and demand for donated oocytes due to ethical considerations. Women of ethnic origin groups must be screened for haemoglobin electrophoresis, sickle cell and Tay-Sachs disease. Adequate and sustained steroid hormone secretion by the corpus luteum of the ovulatory cycle is required for establishing and maintaining pregnancy in humans for the first seven to nine weeks. This chapter discusses oestrogen replacement, progesterone replacement, replacement protocols, oocyte donation in menstrually cyclic recipients, and implantation window. As average life expectancy and quality of life increase, pregnancy from oocyte donation to post-menopausal women becomes more possible.
Fertility is markedly compromised several years before the menopause, suggesting that factors other than complete depletion of the follicular store play a role in the loss of oocyte competency in ageing women. The reduced reproductive potential of older women is related to the functional and structural qualities of the oocytes. Older women are more likely to be affected by a number of pathologies that can reduce their fertility potential. Increasing maternal age is also associated with an increase in ovulatory dysfunction. Reduction in uterine receptivity as a possible contributing factor to the decline in fertility with age has been difficult to ascertain. Fibroids that distort the uterine cavity can reduce the chances of successful implantation. This chapter discusses various assisted reproductive technologies, namely, in vitro fertilization (IVF)/gamete intrafallopian transfer (GIFT), ovarian stimulation for IVF/GIFT, donor insemination, oocyte donation, assisted embryo hatching, blastocyst transfer and preimplantation genetic diagnosis (PGD) of aneuploidies.
This user-friendly, practical guide provides an excellent introduction to good clinical practice in the investigation and treatment of infertility, using the very latest assisted reproductive technologies. There are chapters on clinical assessment of the male and the female, followed by detailed chapters on the full range of clinical procedures that can be put in place to help overcome infertility. In addition, other chapters deal with IVF, GIFT and ZIFT and clinical aspects of PGD, which has an increasingly important role these days. Guidance is given on how to set up and run a successful IVF unit based on the experience of the authors, and for the benefit of those new to the field or responsible for developing an IVF service for their patients. With its clinical focus, this will undoubtedly become an essential introduction to assisted reproduction for doctors, embryologists, and nurses.
Assisted human reproduction continues its worldwide spread as increasing numbers of patients are treated annually, and more clinicians and scientists enter the field each year. Demand for new knowledge remains insatiable whether on the web, in conferences or textbooks. Demand comes from so many quarters, from medical and scientific professionals, teachers, nurses, counsellors, patients and students, each needing information for their own particular ends. Comprehensive texts covering this wide demand are rare, new books mostly being highly specialised to a particular topic or technique.
Good Clinical Practice in Assisted Reproduction offers this comprehensive approach to the clinical aspects of assisted reproduction. It is unusual among the many books covering this field of biomedicine. Setting out to make data available using a simple form of presentation enabling easy searching, data are presented in 20 straightforward but detailed chapters, each debating topics essential to this form of treatment. Stressing clinical care rather than the scientific aspects of human embryology and their application, successive chapters have a simple and attractive style grouping data under sub-headings at regular intervals. Browsing is made easy without any need for constant recourse to indices or other textbooks. Tables are well laid out and direct, diagrams redrawn to a single style giving a highly attractive layout to the book. References are numerous and complete, present full details to chosen articles and offer advanced knowledge to provide data to more advanced readers in the field. Such simple and direct means of projecting its contents make this book attractive to a wide readership searching for an easy-to-read and easily accessible yet responsible text.
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