Female Infertilty: Core Principles and Clinical Management Jayant Mehta, Bryan Woodward
INDEX
ABCDEFGHIKLMNOPPRSTUVWXZ
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Abnormal uterine bleeding (AUB) 21
Absolute uterine factor infertility (AUFI) 143, 144 see also Uterine transplantation (UTx)
ACGH see Array comparative genomic hybridization (aCGH)
Acupuncture 34
Adipose tissue 30
distribution of 30, 31
Age
and chromosomal abnormalities risk 108
and fertility 75
Alcohol consumption, and fertility 10, 33
Amenorrhea
causes of 13
history of 12
AMH see Anti-Müllerian hormone (AMH)
Amniocentesis 108, 124, 137
Anaphase lag 113
Androgens 7, 11, 86
Anembryonic pregnancy 106, 107
Anemia, in pregnancy 9, 29
Aneuploidy 113
Angelman's syndrome 115, 115
Anovulation
and female infertility 23
treatment options 24–25
WHO I hypogonadotropic-hypogonadism 23–24, 24
WHO III hypergonadotropic hypogonadism 24, 24, 25
WHO II normogonadotropic, normogonadism 24, 24
Anticardiolipin antibodies, test for 13
Anticipated gamete exhaustion (AGE) banking 152–153
Anti-Müllerian hormone (AMH) 15, 37, 75
automated assays 37
circadian variation in 39
comorbidities and 38
endocrine environment and 38
ethnicitiy and 38
inter-individual variation 37, 37
intra-individual variation 38–39
obesity and 38
smoking and 38
Antioxidants 29
food sources of 30
reactive oxygen species and 30
Antiphospholipid syndrome 87
Anti-tuberculous therapy 19
Antral follicle count (AFC) 15,15, 39, 75
age-related decline in 40
inter-individual variation 40, 40
intra-individual variation 40
as measure of ovarian reserve 39–40
technical issues in determination of 39–40
Apoptotic wave 5
Aromatase inhibitor 48–49
Array comparative genomic hybridization (aCGH) 118, 119–121, 120
ART see Assisted reproductive technology (ART)
Asherman's syndrome 144
Aspirin 13, 88, 147
Assisted hatching (AH) 89
Assisted reproductive technology (ART) 86, 129
diagnosis of pregnancy 105, 105–106, 106
ectopic pregnancy 106
gestational surrogacy and 91–92 (see also Surrogacy)
heterotopic pregnancy, risk of 106
and miscarriage 106–107
and multiple pregnancies 107–108, 108
Azithromycin 19
B
Barker hypothesis 27
Bartholin's glands 5
Basal body temperature (BBT) 14, 14
Benzathine penicillin G 19
Beta-human chorionic gonadotropin (β-hCG) 105, 106
Bicornuate uterus 22, 22
Bioengineered uterine patch 150
Bisphenol A (BPA) 33
Blastocyst biopsy 117–118, 118
Blastomere biopsy 117, 117
Body mass index (BMI) 9, 30, 30
Bone marrow stem cells 88
C
Caffeine 32–33, 33
Carnitine 34
Carrier screening, for oocyte donors 76
Ceftriaxone 19
Cell culture protocols 130–131
Cell cycle 113, 114
Cell-free DNA 108
Cell-free fetal DNA (cffDNA) 124–125
Cervical cytology 10
Cervical intraepithelial neoplasia 22
Cervical mucus 2, 15, 22
assessment of 15
Cervical polyps 22, 22
Cervix 2
assessment of 22
tight 22
Chlamydia trachomatis infection 19, 19
Chocolate cysts 23
Chorionicity, determination of 107
Chorionic villus sampling (CVS) 108, 124, 124, 137
Chromosomal abnormalities
analytical methods for detection of 118–121
chromosomal structure and origin of 111, 111–112
insertions 115
inversions 115
maternal age and risk of 108
numerical 112–113
reciprocal translocation 114
Robertsonian translocation 114–115
structural 113–115, 114
uniparental disomy 115
Chromosome structure 111, 111, 112
Chronic progressive external ophthalmoplegia (CPEO) 138
Cigarette smoking, and pregnancy 10–11
Cleavage-stage biopsy 117, 117
Clinical commissioning groups (CCGs) 102
Clomiphene citrate (CC) 48, 61
for polycystic ovary syndrome 24
COC see Cumulus-oocyte complex (COC)
Coenzyme Q10 (CoQ10) 33
Colony-stimulating factors (CSFs) 86
Complementary and alternative medicine (CAM) 34
Controlled ovarian stimulation (COS), in oocyte donors 78–79, 151
Corpus luteum 11, 14
Corpus luteum cysts 23
Cortical reaction 66
Counseling services, at fertility clinic 99–100
licence conditions for counseling 99
CPAs see Cryoprotective agents (CPAs)
Crown-rump length (CRL) 107
Cryoprotective agents (CPAs) 153
for oocyte vitrification 154
for ovarian tissue freezing 155–156
Cumulus-oocyte complex (COC) 67, 70
conventional IVF insemination 70–71, 72
CVS see Chorionic villus sampling (CVS)
Cyclosporin A (CsA) 145
Cystadenomas 23
Cystic fibrosis (CF) 77, 116
Cytokines, role of, in implantation 86
D
Dairy products, and fertility 32
Danazol 57, 57, 58
Dehydroepiandrosterone (DHEA) 33
Denudation 71–72
Denudation pipettes 72
Dermoid cysts 23
Diet and lifestyle, impact on fertility see Pre-conception nutrition and lifestyle
Differentiation 129
of human pluripotent cells to oocytes 133–134
of mouse pluripotent cells to oocytes 131–133
Dioxins 31, 32
Dispermy 112
DNA fragmentation index (DFI) 87
Doderlein's bacilli 2, 2, 5
Down syndrome 108, 113, 123
Doxycycline 19
Drug-induced ovulation 61
classical ovulation induction 61
superovulation and IVF 61–62, 62
Drugs in fertility treatment and nutrients, interactions between 34
Duchenne muscular dystrophy (DMD) 116
Dysmenorrhea 13, 53
Dyspareunia 53
E
Early pregnancy, management of 105–108
chromosomal abnormality, tests for 108
gestational sac 105, 106
pregnancy detection and 105–106
ultrasound scan in 105, 105, 106
Ectopic pregnancy 106
Edwards syndrome 113, 123
Elective single-embryo transfer (eSET) 94, 116
Embryonic mosaicism 117–118
Embryonic stem cell (ESC) 129, 129
Embryo transfer (ET) 86, 105
Emotional impact, of infertility 99
Endometrial cancer 22
Endometrial hyperplasia 21–22
Endometrial polyp 21
Endometrial receptivity array (ERA) 88
Endometrial scratch 89
Endometriosis 31, 53, 53
assisted reproductive techniques 58, 58–59
coelomic metaplasia theory 55
deep infiltrating 53
diet and 31–32
epidemiology 53
hormonal treatment 57, 58
and infertility 56, 56, 57–59
locations of lesions 53, 54
magnetic resonance imaging 54
ovarian 53
pain with 53, 57, 57
retrograde menstruation theory 55
risk factors 56
screening for 54
severity classification 54–55, 55
superficial 53
support groups 59
surgical treatment 57, 58
symptoms 53
ultrasonographic diagnosis 54, 54
vascular–lymphatic theory 55–56
and vitamin D supplementation 32
Endometriosis fertility index (EFI) 55
Endometrium 2, 86
assessment of 15–16
hormonal effects on 11, 12
thin 88
Estradiol 6, 11
Estriol 11
Estrogens 11
Estrone 11
European Union Tissues and Cells Directives (EUTCDs) 81
Exercise, effect of 34
Expanded carrier screening (ECS) 76
F
Fallopian tube anatomy and neurovascular supply 3–4, 3, 5
Fatty acids, effects of, on health and fertility 28, 28
Female menstrual cycle
endometrium, hormonal effects on 11, 12
hormonal changes 11, 11
Female reproductive system anatomy and physiology 1–4, 2–4
Fertility counseling process 100
Fertility Europe 100
Fertility Fairness, UK 99, 100, 102
Fertility preservation (FP) 151–157 see also Oocyte preservation; Ovarian tissue cryopreservation
Fertilization 3, 7
conventional IVF insemination 70–71, 72
intracytoplasmic sperm injection 71–73, 73
Fetal alcohol syndrome 10
Fibroids, in uterus 16, 16, 21
Fluorescent in situ hybridization (FISH) 118–119, 119
Folate
deficiency 28
supplementation 10, 28, 105
synthesis 28, 29
Follicle stimulating hormone (FSH) 5, 6, 7, 11, 15, 23–25, 33, 38, 47
Follicular cysts 23
Follicular fluid (FF) 69
Fragile X syndrome (FXS) 24, 76, 78, 78, 79
Frankenhäuser ganglia 5
Freeze-all strategy 87
FSH see Follicle stimulating hormone (FSH)
G
Galactorrhea 16
Galactose 32
Genetic disorders 115
monogenic autosomal dominant disorders 116
monogenic autosomal recessive disorders 115–116
X-linked disorders 116
Gestational diabetes, in oocyte recipients 81
Glycemic control, pre-conception 30
Gonadal dysgenesis 75
Gonadotropin-releasing hormone (GnRH) 6, 7, 11
agonists 61, 79, 86
antagonists 78–79
Gonadotropin therapy 49–50, 50, 50
Gonorrhea 19, 19
Granulocyte colony-stimulating factor (G-CSF) 88
Gynecological examination 14
H
Hemagglutinating virus of Japan envelope (HVJ-E) 139, 140
Hematinics, deficiency of 9
Hematopoietic stem cells (HSCs) 130
Hemoglobinopathies, screening for 10
Hemorrhagic cyst 23
Herbal medicine 34–35
Heteroplasmy 137
Heterotopic pregnancy 106
History taking 12–14, 13
Homoplasmy 137
Hormone replacement therapy (HRT) 25
Human chorionic gonadotropin (hCG) 4, 7, 61, 86
Human Fertilisation and Embryology Act 1990, UK 94, 99
Human Fertilization and Embryology Authority (HFEA), UK 91, 93, 99, 102
licence conditions for counseling 99
on mitochondrial donation 141
Multiple Births Report 2015 107
‘One at a Time’ policy 102
Human leukocyte antigen (HLA) system 86, 88
Human menopausal gonadotropin (hMG) 61
Hyaluronan (HA) 72
Hyaluronidase (Hyase) 71, 72
Hydrosalpinx 20–21, 21, 88
bilateral 20
unilateral 20
Hyperprolactinemia 16
Hypertensive disorders, in oocyte recipients 81
Hypogonadotrophic hypogonadism 16
Hypothalamic–pituitary–ovarian axis 11, 11
Hysterectomy 143
Hysterosalpingography (HSG) 20, 20
Hysterosalpingo sonography 20
contrast saline-based medium (HyCoSy) 20
hyperechogenic foam (HyFoSy) 20
Hysteroscopy, for uterine cavity evaluation 87–88
I
ICSI see Intracytoplasmic sperm injection (ICSI)
Immunomodulatory therapies 88
Implantation 7, 85
adhesion stage 85, 85
apposition phase 85, 85
cumulus cells in, role of 86
definition 85
failure (see Recurrent implantation failure (RIF))
hormonal factors and role of cytokines 86
immune system, role of 86
invasion stage 85, 85
and natural selection 86
window of 86
Imprinting 115
Induced pluripotent stem cells (iPSCs) 129, 129
Infertility
definiton of 9
endocrine investigations 16
examination in 14
female menstrual cycle and 9
history 12–14
preconception issues 9–11
reproductive function assessment 14–16
Injectable gonadotropins 61
Inner cell mass (ICM) 129
Insertions, chromosomal 115, 114
Insulin levels, measurement of 16
Insulin sensitizers 49
Interchromosomal effect (ICE) 121
Intercourse frequency, and infertility 12
Interleukin (IL) systems 86
Intraclass correlation coefficient (ICC) 39
Intracytoplasmic sperm injection (ICSI) 19, 65, 71–73, 73, 140
considerations for 73
injection procedure 72–73
intracytoplasmic morphologically-selected sperm injection (IMSI) 73
micromanipulation equipment 72, 73
motile sperm organelle morphology examination (MSOME) 73
oocytes preparation for 71–72
polyvinylpyrrolidone, use of 74
Intraluminal fibrosis 20
Intrauterine insemination (IUI) 91
Intrauterine pregnancy of unknown viability 106
Intrauterine synechaie 21
Inversions 115
paracentric 115
pericentric 115
In vitro fertilization (IVF) 7, 19, 20, 65, 86 see also Recurrent implantation failure (RIF)
funding and financial issues 101–102
insemination procedure 70–71, 72
for women with polycystic ovaries 50–51
Iodine, in pregnancy 29
Iron deficiency anemia 29
Iron supplementation, in pregnancy 29
IVF see In vitro fertilization (IVF)
K
Karyotyping 13, 77–78, 88
Kearns–Sayre syndrome (KSS) 138
Klinefelter syndrome 113
L
Laparoscopic oocyte recovery 69 see also Oocyte collection
Laparoscopic ovarian drilling (LOD) 50
L-arginine 88
Leber's hereditary optic neuropathy (LHON) 138
Leigh syndrome 138
Letrozole 25, 48–49, 61, 151
Leukemia inhibitory factor (LIF) 86
Lichen simplex chronicus (LSC) 14
Low molecular weight heparin 13
Lupus anticoagulant, test for 13
Luteal phase deficiency (LPD) 23
Luteal phase progesterone 7
Luteinizing hormone (LH) 4, 6, 6, 11, 23
M
Macronutrients
carbohydrates 27
fats 28, 28
female reproduction, influence on 27
protein 28
Macroprolactin 16
Massively parallel shotgun sequencing (MPSS) 125
Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome 14, 91, 143 see also Müllerian agenesis
Meal timing and body weight 31
Mean corpuscular volume (MCV) 78
Mean sac diameter (MSD) 106
Measles, mumps and rubella (MMR) vaccination 9–10
Mediterranean diet 27, 27
Melatonin 34
Menstruation 11
amount of bleeding during 13
Metabolomics 68
Metformin 30, 49
Methotrexate 106
Microdeletion screening 126
Micronutrients 28
folate 28, 29
iodine 29
iron 29
vitamin D 28–29
Miscarriage 106–107
recurrent 13
Misoprostol 107
Mitochondria 137, 137
Mitochondrial DNA (mtDNA) disease 137, 138 see also Mitochondrial donation
oocyte donation 138
preimplantation genetic diagnosis 138
prenatal genetic diagnosis 137–138
reducing/avoiding of, options for 137–138
Mitochondrial donation 137, 138
cytoplast lysis 141
karyoplast lysis 141
procedure 140–141
pronuclei (PN) transfer 139, 139–140, 140
regulation 141
spindle transfer 138, 139
training for 141
Mitochondrial encephalomyopathy, lactic acidosis, stroke-like symptoms (MELAS) 138
Mitotic polyploidy 112, 112
Modified Strassman procedure 143
Monochorionic pregnancies 107
Monogenic autosomal dominant disorders 116
Monogenic autosomal recessive disorders 115–116
Mosaicism 113
in trophectoderm biopsies 117–118
Multiple cysts, in ovaries 23
Multiple pregnancy 107–108
chorionicity in 107
and preterm delivery risk 108
risks associated with 108
Multiplex polymerase chain reaction 118, 119
Mycophenolate mofetil (MMF) 146
Mycoplasma (Ureaplasma urealyticum) 19, 20
Myoclonic epilepsy with ragged-red fibers (MERRF) 138
Myo-inositol 34
Myotonic dystrophy 116
N
Nabothian cysts 2, 5
Neisseria gonorrhoeae 19, 19–20
Neural tube defects 105
Neurodermatitis 14
Neuropathy, ataxia and retinitis pigmentosa (NARP) 138
Next-generation sequencing (NGS) 118, 121
NIPT see Noninvasive prenatal testing (NIPT)
Nondisjunction 113, 114
Nongrowing follicles (NGFs) 37
Noninvasive prenatal testing (NIPT) 108, 123, 137–138
amniocentesis 108, 124, 137
biology and screening tests 124–125
chorionic villus sampling 124, 124
clinical applications 125–126
combined test 123, 123
future of 126–127
integrated test 123, 123–124
massively parallel shotgun sequencing (MPSS) 125
methods 125
quadruple test 123, 123–124
qualitative single nucleotide polymorphism (SNP) 125
targeted massively paralleled sequencing (MPS) 125
timing of testing 124
ultrasound scanning and biochemical markers combination 123, 123–124
Nucleic acid amplification tests (NAT) 10
Nurses’ Health Study II 28
Nutrition and fertility, link between see Pre-conception nutrition and lifestyle
O
Obesity
insulin resistance in 16
and pregnancy 9
OHSS see Ovarian hyperstimulation syndrome (OHSS)
Oligomenorrhea 23, 24
Oligozoospermia 19
Omega three fatty acids 32
Online support 101
Oocyte 4, 5, 6, 11, 65, 129
biological structure 65–67
centrosome 66–67
checking for fertilization 73, 73
collection procedure (see Oocyte collection)
conventional IVF insemination 70–71, 72
cortical granules (CGs) 66, 67
fertilized 7
grading 68
intracytoplasmic sperm injection 71–73, 73
mitochondria 67
oolemma 65
ooplasm 65, 66
perivitelline space (PVS) 65, 66
quality, assessment of 67–68, 68
shapes and sizes 68, 68
smooth endoplasmic reticulum (SER) and SER discs 67, 67
transzonal projections (TZPs) 65, 66
in vitro differentiation to oocytes 130–131
in vitro maturation (IVM) 151, 154–155
in vitro processing of, in IVF laboratory 69–70, 71
in vivo oocyte development 130, 131
zona pellucida 65–66, 66
Oocyte aneuploidy 67
Oocyte banking
cycles without super-ovulation 151–152
cycles with super-ovulation 151
Oocyte collection
day before 68–69
double lumen needle use 69
high aspiration pressure during 69, 70
methods for 69
preparation for 68
single lumen needle use 69
Oocyte donation 75
altruism 81–82
blood tests 76
carrier screening tests 76
compliance 82
confidentiality 82
controlled ovarian stimulation for 78–79
donor candidate, selection of 75–76
genetic screening 76–77
international legislation and legal framework 81, 81
karyotyping 77–78
medical interview 76
number of children born from one donor 82
for older women 75
physical and gynecological examination 76
use of, reasons for 75
Oocyte preservation
for anticipation of gamete exhaustion 152–153
for oncofertility 151–152
by slow freezing 153
by vitrification 153 (see also Vitrification of oocytes)
Oocyte recipients
artificial endometrial cycle 80
endometrial preparation in 80
medical tests for 79, 79–80
natural or modified natural cycle 80
obstetrical risks in 80–81
Oocyte vitrification 151, 153 see also Vitrification of oocytes
Oogenesis and oocytes production
follicular growth 5
indifferent gonad stage 5
oogonal multiplication and oocyte formation 5
ovarian differentiation 5
Oral ovulation induction (OI) 25
Ovarian cysts 23, 23
Ovarian drilling 13, 13, 25
Ovarian endometrioma 23
Ovarian follicles 4
Ovarian hyperstimulation syndrome (OHSS) 49, 62–63, 63, 78, 151
Ovarian reserve 13, 15, 23, 37
Ovarian response, biomarkers for 37
AMH and AFC performance, comparison of 41–43, 42, 42
anti-Mullerian hormone 37–39
antral follicle count 39–40
tailoring treatment based on 43, 43
Ovarian stimulatory medications 61
Ovarian tissue banking 152
Ovarian tissue cryopreservation
ex-vivo oocyte harvesting and IVM 156–157
ovarian cortex preparation 155, 156
ovarian tissue freezing 155–156
Ovaries 22–23
blood supply to 4
early development of 5
hormone receptor expression 6–7
innervation of 4
morphology of, checking of 23, 23
structure of 3–4, 6
Oviducts see fallopian tubes
Ovulation 14
assessment of 14–15
induction, medications for 61
Ovulation predictor kits 14, 94
Ovulatory disorders 23 see also Anovulation
P
Parthenogenetic stem cells (PSCs) 129, 129
Patau syndrome 113, 123
PCOS see Polycystic ovary syndrome (PCOS)
Pearson syndrome 138
Pelvic inflammatory disease (PID)
and female infertility 19
sexually transmitted infections 19, 19–20
Pelvis, ultrasound assessment of 16, 16, 21
Pentoxifylline 88
PGT see Preimplantation genetic testing (PGT)
Phytoestrogens 32, 33
Polar body biopsy 117
Polarized light microscopy, for oocyte assessment 68
Polycystic ovary syndrome (PCOS) 7, 24, 47, 87
anti-Müllerian hormone level 47
aromatase inhibitor 48–49
clomifene citrate 48
definition 47
etiology 47
gonadotropin therapy 49–50, 50, 50
hyperinsulinemia in 47
insulin resistance in 166
insulin sensitizers 49
laparoscopic ovarian drilling 50
management of infertility with 47–51
pathophysiology 47
treatment for 25
in vitro fertilization 50–51
weight loss 48
Polyploidy 112–113
Polyspermy 66
Polyvinylpyrrolidone (PVP) 74
Postcoital test (PCT) 15, 22
Potency
concept of 129–130
demonstration of 130
nullipotency 129
pluripotent cells 129, 129
reduction of, through differentiation 130
totipotency 129
in vitro differentiation to oocytes 130–131
in vivo oocyte development 130, 131
Prader–Willi syndrome 115, 115
Preconception counseling see also Pre-conception nutrition and lifestyle
alcohol 10
anemia 9
caffeine 11
cervical cytology 10
folate 10
hemoglobinopathies 10
obesity 9
rubella infection 9–10, 10
sexually transmitted infections 10
tobacco 10–11
Pre-conception nutrition and lifestyle
alcohol 33
bisphenol A 33
body mass index and body fat 30, 30
caffeine 32–33, 33
complementary and alternative medicine 34–35
dairy products 32
diet and endometriosis 31–32
exercise 34
macronutrients 27–28, 28
Mediterranean diet 27, 27
micronutrients 28–29, 29
novel supplements and nutraceuticals 33–34
overweight 30–31, 31
phytoestrogens 32, 33
reactive oxygen species and antioxidants 29, 30
smoking 33
underweight 31
vegetarian and vegan diets 32
Prednisolone 146
Pre-eclampsia, in oocyte recipients 81
Preimplantation genetic diagnosis (PGD) 75, 138
Preimplantation genetic testing (PGT) 112, 116
for aneuploidy 116
blastocyst biopsy 117–118, 118
cleavage-stage biopsy 117, 117
polar body biopsy 117
for structural rearrangements/monogenic disorders 116
Premature ovarian failure 75
Premature ovarian insufficiency (POI) 24, 25
Primordial germ cells (PGCs) 129, 130
PGC-like cells (PGCLCs) 133
Progesterone 6, 7, 11, 14
ovulation and level of 14–15
Progesterone receptor (PR) expression 7
Progesterone test 15, 16
Progesterone withdrawal bleed 16
Prolactin 16
and infertility 16
Progestogens 16, 61
P
Qualitative single nucleotide polymorphism (SNP) 125
R
Rare autosomal trisomies (RATs) 126
Reactive oxygen species (ROS) 29
Reciprocal translocation 114
Recurrent implantation failure (RIF) 86
altered sex steroids and 87
and assisted hatching 89
embryonic genetic aneuploidy and 86–87
endometrial receptivity assessment 88
endometrial scratch, use of 89
gynecological diseases and 87
hydrosalpinx and 88
immunological factors 87, 88
investigations and possible treatments 87–89
and karyotyping 88
oocyte quality and 87
sperm quality and 87
thin endometrium and 88
thrombophilias and 87, 88
uterine cavity evaluation 87–88
Reference nutrient intake (RNI) 29
for iodine 29
Reproductive function, assessment of
anti-Müllerian hormone 15
antral follicle count 15, 15
cervical mucus 15
endometrium 15–16
ovarian reserve testing 15
ovulation 14, 14–15
pelvic scan 16, 16
woman's age and serum follicle stimulating hormone 15
Reprogramming 129
Resistant ovary syndrome 24
Resveratrol 32
Rete ovarii 4
RIF see Recurrent implantation failure (RIF)
Robertsonian translocation 114–115
Rubella infection, in pregnancy 9–10, 10
S
Salpingectomy 20–21, 88, 106
Salpingitis isthmica nodosa (SIN) 20
Salpingotomy 106
Secondary infertility care, investigations in 19
aim of 19
anovulation 22–25, 23
cervix 22, 22
fallopian tubes 19, 19–21, 20
ovaries 22–23, 23
uterine cavity 21–22
Selective salpingography, for proximal tubal disease 20, 21
Self-renewal 129
Serum insulin 16
Serum prolactin 16
Sex steroid hormones, ovarian-derived 6
Sexually transmitted infections (STIs)
pelvic inflammatory disease and tubal blockage by 19, 19–20
screening for 10
Sickle-cell anemia (SCA) 77
Sickle-cell disease (SCD) 77, 78
Sildenafil 88
Skene's gland 5
Smoking, effect of 10–11, 33
Somatic cell nuclear transfer (SCNT) pluripotent cells 129, 129
Soya phytoestrogens 32
Speculum examination 14
Sperm DNA testing 87
Spina bifida 10
Spinal muscular atrophy (SMA) 77, 77
Submucosal fibroid, on hysterosonogram 21, 22
Superovulation 61, 62
cycle monitoring 62
long protocols 61–62
luteal support after 63
and ovarian hyperstimulation syndrome 62–63
short protocols 62
Support groups 100–101
aim of 100
in Europe 103
male partners, support for 101
online support 101
specialist 101
support after unsuccessful treatment 102–103
support in clinic 101
Surrogacy 91 see also Surrogate
altruistic 92
commercial 92
contract 95
counseling for 95
cross-border 95
embryo creation 95
ethical considerations 95–96
gestational 91–92, 92, 94
incidence of 93
legal parenthood 92–93
legal perspectives 92, 93
as option for parenthood, reasons for 91, 91
Parental Orders 93
procedures 94
screening for 94
sperm provider 94
success rates 95
traditional 91, 92, 94
types of 91–92, 92
Surrogacy Arrangements Act 1985, UK 94
Surrogate 91
anonymous 93
criteria 93–94
Syphilis (Treponema pallidum) 19, 20
T
Tacrolimus 145, 146
Tamoxifen 61
Targeted massively paralleled sequencing (MPS) 125
Testosterone 6
Tetraploidy 112, 112
Textured vegetable protein (TVP) 32
Thalassemias 77, 115
alpha thalassemia 77
beta thalassemia 77
Thrombophilias
and implantation failure 87
and recurrent pregnancy losses 87, 88
Thymoglobulin 146
Timed intercourse 12
Transforming growth factor beta 1 (TGF-b1) 86
Transvaginal ultrasonography (TVS)
antral follicle count 39
cervical polyps 22, 22
in early pregnancy 105, 106
endometriosis 54, 54
ovarian morphology 23
Triploidy 112
Trisomies 113, 113
Trisomy 21 see Down syndrome
Tubal infertility 19–20
distal tubal blockage 20
pelvic inflammatory disease and 19, 19–20
pelvic surgery and 20
previous pelvic pathology and 20
proximal tubal blockage 20
Tubal patency, investigations for 20
hysterosalpingography 20, 20
hysterosalpingo sonography 20
and management 20–21
Tuberculosis (Mycobacterium tuberculosis) 19, 20
Turner syndrome 113
U
Ultrasound-guided follicle aspiration 69 see also Oocyte collection
Under-nutrition and fertility, relationship between 31
Unicornuate uterus 22, 22
Uniparental disomy 115
Uterine fibroids 14, 16, 21, 22
Uterine malformations 22, 22
and miscarriage 22
Uterine natural killer (uNK) cells 86, 87
Uterine transplantation (UTx) 91, 143
animal models, lessons from 144–145
Asherman's syndrome and 144
bioengineered uterine patch 150
donor inclusion and exclusion criteria 148
donor surgery incisions 148
future prospects 147–148
history 144
human cases, lessons from 145–147
hysterectomy and 143
intrafamilial donation 149
living donors, use of 148–149
MRKH syndrome and 143
radical hysterectomy 149–150
recipient anatomy following uterine transplantation 149
recipient inclusion and exclusion criteria 148
recipient preoperative counseling and investigations 147
transgender donors 149
uterine transplant graft following retrieval 149
Uterus
anatomy of 2, 2–3, 4
assessment of 21–22
menstrual cycle and 3
V
Vagina anatomy and neurovascular supply 1–4, 2
Vaginal progesterone 63
Vegetarian and vegan diets 32
Visceral adipose tissue 30, 31
Vitamin D
and endometriosis 32
infertility and 29–30
Vitrification of oocytes 153
cryoprotectants 154
devices 154, 154
procedures 153
vitrification and warming protocol 155
Vulva 1, 1
Vulvar intraepithelial neoplasia (VIN) 14
W
Weight loss 24
and fertility 24
polycystic ovary syndrome and 48
Weight loss surgery, and conception 9
Wheat/gluten-free diets 32
Whole genome amplification (WGA) and analysis 127
Window of implantation (WOI) 86
disturbance in 87
World Health Organization (WHO), anovulation classification by 23–24, 24
X
X-linked disorders 116
Z
Zona pellucida (ZP) 65–66, 66
Zygote 7
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FEMALE INFERTILITY CORE PRINCIPLES AND CLINICAL MANAGEMENT
FEMALE INFERTILITY CORE PRINCIPLES AND CLINICAL MANAGEMENT
Bryan Woodward PhD FRCPath Consultant Reproductive Scientist X & Y Fertility Ltd Leicester, UK Jayant Mehta PhD DipRCPath Sub-Fertility Laboratory Director Quality Control Manager Barking, Havering and Redbridge NHS University Trust Romford, UK
© 2020 Jaypee Brothers Medical Publishers
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This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
9781909836501
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A catalogue record for this book is available from the British Library
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A catalog record for this book is available from the Library of Congress
Development Editor:   Harsha Madan
Editorial Assistant:   Keshav Kumar
Cover Design:      Rakesh Kumar
Preface
Pregnancy outcomes are highly dependent on oocyte quality. Although sperm quality influences fertilization, embryo development and implantation, it is the oocyte that orchestrates these processes to produce a successful pregnancy and a healthy baby. The birth of Louise Brown in 1978 marked the beginning of our journey towards an understanding of the dynamics of assisted female reproduction. Today, four decades later, our efforts to expand and improve on this knowledge are greater than ever.
The purpose of Female Infertility: Core Principles and Clinical Management is to provide a comprehensive understanding of various aspects of female reproduction in order to overcome infertility with appropriate treatments.
The book opens with an introduction to the basic anatomy and physiology and concludes with a chapter on fertility preservation for future treatment. Chapters in between cover a broad range of topics: those dedicated to investigative techniques describe how to establish the physiologically normal functionality of the ovaries, the measurement of ovarian reserves, stimulation protocols and the process of oogenesis and oocyte collection.
Conditions such as polycystic ovarian syndrome and endometriosis influence the quality of oocytes and implantation. Dedicated chapters therefore address the underlying causes of these diseases and how to treat them to achieve successful pregnancies. The preservation of oocytes offers women facing chemo- or radiotherapy the opportunity to realize their reproductive potential: relevant techniques and concepts are described in chapters on cryo-banking and oncology. Concluding chapters address future technologies, including deriving oocytes from stem cells. Correcting mitochondrial disease by application of the three-parent child concept is also discussed. The dynamic journey of describing female reproduction ends with a chapter on transplantation of cryopreserved ovaries.
Female Infertility: Core Principles and Clinical Management is richly illustrated throughout and we hope it will serve as an essential resource for all clinicians, nurses and clinical scientists specialising in reproductive medicine, gynecology, oncology, infertility and embryology.
Bryan Woodward
Jayant Mehta
March 2019
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