The Art and Science of Assisted Reproductive Technique (ART) Gautam N Allahbadia, Rubina Merchant, Rita Basuray Das
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1The Art and Science of Assisted Reproductive Techniques (ART)2
3The Art and Science of Assisted Reproductive Techniques (ART)
Editors Gautam N Allahbadia MD DNB Scientific Director, Rotunda-Center for Human Reproduction Mumbai, India Consultant, Rotunda-Virk Center for Human Reproduction Jalandhar, India Consultant, Rotunda-Hygeia Center for Human Reproduction Srinagar, India Consultant, Rotunda-Southend Center for Human Reproduction New Delhi, India Consultant, Bombay Hospital and Medical Research Centre Mumbai, India Rita Basuray Das PhD Medical Liaison Executive Department of Reproductive Health North America Serono USA Assistant Editor Rubina Merchant PhD Embryologist, Rotunda-Center for Human Reproduction Mumbai, India Foreword by Bruno Lunenfeld MD FRCOG FACOG (hon) POGS (hon) Faculty of Life Sciences Bar -Ilan University Ramat Gan 52900 Israel
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The Art and Science of Assisted Reproductive Techniques (ART)
© 2003, Gautam N Allahbadia, Rita Basuray Das
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the contributors, FOGSI, and the publisher.
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5
dedicated to our spouses Swati and Sumit
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7Foreword
Prof Bruno Lunenfeld, md, frcog facog (hon) pogs (hon)
Faculty of Life Sciences, Bar -Ilan University Ramat Gan 52900 Israel
The “conquest of infertility” is an incredible achievement, it is a victory of human will, endurance and technology. However as we have entered the new millennium, new challenges are arising in relation to scientific, ethical and humanitarian aspects in infertility management. However, in spite of our increasing knowledge and skills many questions remain unanswered and new concerns and problems constantly arise. In the early nineties, ICSI was still an experimental therapeutic approach yet in the meantime it has revolutionized the treatment of male infertility worldwide. Testicular sperm extraction for ICSI and cryopreservation techniques are important milestones in assisted reproductive technology while in vitro maturation of germinal cells the intracytoplasmic injection of round and elongated spermatids are still in the experimental stage. In the last few years new compounds such as recombinant gonadotropins (FSH LH and hCG) and GnRH antagonists came into use for ovulation induction and controlled ovarian stimulation which improved safety, allows for individualized adjusted therapies and make treatment more patient friendly. Pre-implantation genetic diagnosis is improving but most genetic implications of assisted reproduction are still under debate. Oocyte donation is now widely practiced, but the moral, ethical and judiciary issues of Oocyte sharing spreading from country to country and surrogacy by embryo transfer is are still under debate. There is also an important public demand for information and transparency regarding pregnancy and fetal outcome after ART. The relative excessive rate of high order multiple pregnancies with negative effects on mother and child has still to be accepted by all as a serious complication. More efforts are needed to reduce multiple pregnancy rate as well as the occurrence of hyperstimulation and its consequences. Those involved in reproductive medicine must, on the one hand, make all possible efforts to enable conception to all couples desiring it and, on the other hand, make the utmost to try to avoid maternal and neonatal complications such as the hyperstimulation syndrome, multiple pregnancy and premature delivery. These are formidable goals and this book attempts with theoretical considerations, discussions and newer insights into many aspects within the broad aspect of assisted reproduction to become an important tool for those interest in the field of reproductive medicine
It covers the basics of reproductive endocrinology, theoretical and practical aspects of ovarian stimulation and modern understanding and management of PCOS. The book describes recent developments in drug research with reference to both “gonadotropins, GnRH antagonists and newer delivery systems. Besides useful sections on Endoscopy, Third Party Reproduction, and Implantation a chapter dedicated to stem cell culture and replication written by prominent scientists can be found.
This is a truly comprehensive book for the Obstetrician and Gynecologist who is yearning for knowledge in the field of ART.
This book has brought together leading medical and scientific experts who describe in a clear and concise manner the “how, why and therefore” of ART. It has been written to be readable and usable by research fellows, who want to get an insight into the technical developments, by a clinical and scientific team who want to know the A to Z of setting up an ART program, as well as “veterans” in the field who want an up-to-date review on the newest techniques and advances.
Bruno Lunenfeld8
9Preface
In his famous preface to Cromwell, Victor Hugo pointed out that one seldom inspects the cellar of a house after visiting its salons nor examines the roots of a tree after eating its fruit. The readers of this book will judge it by the substance of its contents and its style, not by a pretext. If the guest has returned several times, then surely he knows that the cellar is well stocked. Having said this, it is reasonable to ask why prefaces and forewords are written and are they ever read? My contribution is intended to present the objectives of this book.
Within the last two decades, the amount of information generated by theoretical and clinical research in the field of reproductive physiology and infertility has increased so enormously that it has become virtually unmanageable. To be professionally efficient, however, both the research worker and the clinician must constantly keep abreast with recent developments and discoveries.
The different chapters in the book cover a wide range of reproductive medicine and science. They represent the cutting-edges of our discipline and are written by acknowledged experts in the field. The editors demonstrated an exceptional capacity to select contributors who are at the forefront of their disciplines, thereby ensuring the freshness of each chapter.
To convey the essence of a rapidly growing field in a single book, it is necessary to be selective in both the extent and depth of coverage. This is especially true for a book designed for students, researchers and practitioners of medicine. This book covers the “classical problems” of reproductive medicine, including stimulation protocols, ART procedures, implantation, cryopreservation, endocrinological disorders, male factor, endoscopy and ultrasonography. Chapters on third party reproduction, PGD, unsolved problems such as treatment of poor responders, treatment of the older patients and endometriosis, and the future of infertility therapy provide important and recent information, as well as food for thought.
I sincerely hope that young doctors and experienced clinicians, medical students and teachers, as well as scientists working in the field of reproductive medicine and endocrinology, will find this book interesting and helpful. Moreover, I sincerely hope that this overview will stimulate new work and a continuous dialogue between basic scientists and clinicians, between gynecologists and andrologists, and between immunologists, endoscopic surgeons and psychologists. Without doubt, teams of highly specialized scientists and clinicians must teach reproductive medicine, and infertile couples should be treated as a unit by specialists with a broad scientific basis and clinical experience in the diagnosis and therapy of both male and female infertility.
I would like to express my appreciation to all the authors for their valuable contributions. They produced a book that is not only of critical substance but is also a real pleasure to read.
Dusseldorf, Germany
Hugo C Verhoeven md10
11List of Contributors