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Gynecological Endoscopy and Infertility
Gautam N Allahbadia, Rubina Merchant, Hugo C Verhoeven, Rudy Leon De Wilde
SECTION 1: LESSONS LEARNT IN INFERTILITY
CHAPTER 1:
Treatment of Infertility and its Historical Context
ABSTRACT
INTRODUCTION
DISORDERS OF THE HYPOTHALAMIC-HYPOPHYSEAL SYSTEMS
Reproductive Hormone Technology
Diagnosis
Women
Men
Treatment
Women
DIAGNOSIS AND TREATMENT OF MECHANICAL CAUSES OF INFERTILITY USING MICROSURGICAL TECHNIQUES
Diagnosis
Women
Treatment
Men
Women
STRESS AND REPRODUCTION
Diagnosis
Women
Men
Treatment
Female
Men
CONCLUSION
CHAPTER 2:
Fertility Assessment Refined
INTRODUCTION
FERTILITY ASSESSMENT
General Investigations
Assessing the Female Partner
Physical Examination
Endocrine Profile
Evidence of Ovulation
Assessment of Uterine Receptivity
Assessment of Tubal Patency and the Uterine Cavity
Assessment of the Male Partner
Semen Analysis, and Culture
Tests of Sperm Function
SUMMARY
CHAPTER 3:
Current Approaches in the Diagnosis and Treatment of Male Infertility
INTRODUCTION
CURRENT METHODOLOGY IN THE DIAGNOSIS OF MALE INFERTILITY
Genetic Basis of Male Infertility
ASSISTED REPRODUCTIVE TECHNIQUES FOR MALE INFERTILITY
Sperm Morphology Defects
Applications of PGD
Cryopreservation
FUTURE PROSPECTS
CHAPTER 4:
Does Endometriosis Affect Infertility?
INTRODUCTION
ASSOCIATION BETWEEN ENDOMETRIOSIS AND CLINICAL INFERTILITY
Yes, there is an Association
No, there is No Association
PATHOPHYSIOLOGY OF INFERTILITY IN PATIENTS WITH ENDOMETRIOSIS
Peritoneal Fluid Abnormalities
Cellular Components of Peritoneal Fluid; Macrophages and Lymphocytes
Embryo Growth
Sperm Motility and Binding
Vascular Endothelial Growth Factor (VEGF) and Interleukins
Prostaglandin Levels
Increase in Fluid Volume
Eutopic Endometrium Abnormalities
Myometrial Architecture and Peristalsis Abnormalities
Follicular Environment and Embryo Quality
Ovulation Disorders
Anovulation
Hyperprolactinemia
Abnormal Follicular Dynamics
Luteinized Unruptured Follicle Syndrome
Luteal Phase Defect (LPD)
Immunological Abnormalities
Cell-Mediated Immunological Factors
Humoral Immunological Factors
Spontaneous Abortion
Implantation
Pelvic Pain
ASSISTED REPRODUCTIVE TECHNOLOGY IN PATIENTS WITH ENDOMETRIOSIS
CONCLUSION
CHAPTER 5:
Current Perspectives on the Management of Endometrioma
ABSTRACT
INTRODUCTION
PATHOGENESIS
DIAGNOSIS OF ENDOMETRIOMA
Ultrasonography
Magnetic Resonance Imaging
Laparoscopy
MANAGEMENT OF ENDOMETRIOMA
Ultrasound-guided Aspiration
Surgical Approach in the Management of Ovarian Endometrioma
Optimal Operative Technique for Endometrioma
Role of Medical Treatment Before or After Surgery
MANAGEMENT OF ENDOMETRIOSIS IN PATIENTS WITH INFERTILITY
Infertility and Endometriosis
Role of Controlled Ovarian Hyperstimulation with Intrauterine Insemination
In Vitro Fertilization Outcome in Patients with Endometriosis
Why do Patients with Endometriosis have Lower Pregnancy Rates with IVF?
CLINICAL ISSUES IN IVF PATIENTS
Role of Cyst Aspiration Prior to Starting Stimulation
Impact of Endometrioma on Oocyte Aspiration, and Oocyte and Embryo Quality
Impact of Endometriosis on Implantation
Improving IVF Success Rates in Patients with Endometriosis
Role of Gonadotropin-Releasing Hormone Agonist Treatment Prior to IVF
Role of Surgical Treatment of Endometrioma Prior to IVF
CONCLUSION
CHAPTER 6:
Should In Vitro Fertilization/Embryo Transfer (IVF/ET) be the First-line Approach to the Management of Infertility in Women with Endometriosis?
ABSTRACT
INTRODUCTION
Causes of Infertility in Endometriosis
CLINICAL DISCUSSION
Management of Infertility in Women with Endometriosis: Surgical Resection
Hormonal Suppression
Ovulation Induction/Artificial Insemination
In Vitro Fertilization/Embryo Transfer (IVF/ET)
RATIONALE FOR THE USE OF IVF/ET AS THE FIRST-LINE APPROACH TO THE MANAGEMENT OF INFERTILITY IN ENDOMETRIOSIS
CASE STUDIES
COH+AIH vs. IVF-ET in Women with Endometriosis
CONCLUSION
CHAPTER 7:
Insulin Sensitizers in Polycystic Ovary Syndrome
INTRODUCTION
INSULIN RESISTANCE AND HYPERINSULINEMIA AND THE RELATIONSHIP WITH HYPERANDROGENISM
Hyperandrogenism due to Hyperinsulinemia or Hyperinsulinemia due to Hyperandrogenism?
INSULIN SENSITIZERS IN THE TREATMENT OF HYPERANDROGENISM, INSULIN RESISTANCE AND ANOVULATION IN PCOS
Effects of Metformin on Spontaneous and Clomiphene-Induced Ovulation in PCOS
Summary of Published Studies on the Effect of Metformin Alone on Menstrual Cycles in Unselected Women with PCOS
Metformin in Combination with CC and Ovulation and/or Pregnancy
CC-Resistant PCOS: Metformin in Combination with CC and Ovulation and/or Pregnancy
Metformin Use in Ovulation Induction with Gonadotropin
Metformin Use in IVF
Protection from Pregnancy Loss
Use of Metformin as Chronic Therapy in PCOS
Is PCOS a Pre-diabetic State?
Metformin and Prevention of Diabetes
CHAPTER 8:
Insulin Resistance in PCOS
INTRODUCTION
HYPERINSULINISM AND HYPERANDROGENISM
Mechanism Of Hyperinsulinemia In Pcos
Exaggerated Beta Cell Function
Target Cell Insulin Resistance
Insulin Clearance in PCOS
Insulin and Androgen: Interdependence
Detection of Insulin Resistance
LONG-TERM SEQUELAE
Increased Risk of Cardiovascular Disease
Increased Risk of Diabetes
No Risk of Osteoporosis
Risk of Cancer
Treatment
Weight Loss
Insulin Sensitizing Agents (ISA)
Infertile PCOS
CHAPTER 9:
PCOS: Role of Hyperinsulinemia
INTRODUCTION
INSULIN AND PCO
ANDROGENS AND INSULIN RESISTANCE
HYPERINSULINEMIA AS A CAUSE OF HYPERANDROGENISM
GENETIC ASSOCIATION OF POLYCYSTIC OVARY SYNDROME AND INSULIN RESISTANCE
INSULIN SENSITIZERS
CHAPTER 10:
How do we Treat Prolactinomas in Infertility?
ABSTRACT
INTRODUCTION
Pituitary Incidentaloma
PHYSIOLOGY OF PROLACTIN
Prolactin and Male Reproduction
Role of Prolactin in Female Reproduction
CAUSES OF HYPERPROLACTINEMIA
DIAGNOSIS OF PITUITARY PROLACTINOMAS
PATHOGENESIS OF PROLACTINOMAS
NATURAL HISTORY OF PROLACTINOMA
TREATMENT
Results of Treatment
Other Dopamine Agonists
Surgery
Radiotherapy
PREGNANCY IN WOMEN WITH PROLACTIN ADENOMAS
Effect of Pregnancy on Prolactinomas
Effect of Dopamine Agonist Therapy on the Fetus
CONCLUSIONS AND IMPORTANT POINTS TO CONSIDER
FURTHER STUDIES
ACKNOWLEDGMENTS
CHAPTER 11:
Sexual Intercourse Immunology: Antisperm Antibodies
OVERVIEW
PREVALENCE
ORIGIN OF ANTISPERM ANTIBODIES AND THE IMMUNE SYSTEM
CANDIDATE ANTIGENS ON SPERM
MECHANISMS OF ASA-MEDIATING INFERTILITY
POSSIBLE RISK FACTORS INVOLVED IN ASA PRODUCTION
INDICATIONS FOR THE DETERMINATION OF ASA AS A POSSIBLE REASON FOR INFERTILITY33
DIAGNOSIS
ASA assays and their principles
Comments Related to Methods and Techniques
EFFECT OF ASA LOCATION AND ISOTYPE ON SPERM FUNCTION AND FERTILIZATION RATE
ASA TREATMENT
CONCLUSIONS AND REMARKS
CHAPTER 12:
The Role of Immunotherapy in Infertility Management
ABSTRACT
INTRODUCTION
IMMUNOLOGICAL FACTORS
Th1/Th2 Cytokine Balance
HLA Expression
Natural Killer Cells
Antisperm Antibodies
Indoleamine 2,3-Dioxygenase
Leukemia Inhibitory Factor
Blocking Antibodies
Coagulant Factors and Anticardiolipin Antibodies
CLINICAL DISCUSSION AND CASE STUDIES
PREDICTIVE FACTORS
RECENT ADVANCES AND CONCLUSION
CHAPTER 13:
Imaging in Infertility: 2004
INTRODUCTION
METHODS, TECHNIQUES AND EQUIPMENT
Equipment
Voluson 730 Expert (Fig. 13.1)
THE USE OF ULTRASOUND IN INFERTILITY
Infertility Investigation
Morphologic Evaluation
Functional Evaluation
Fertility Monitoring
CONCLUSION
CHAPTER 14:
Hysterosalpingography (HSG) versus Hysterosalpingo-Contrast Sonography (HyCoSy) in Infertility Management
INTRODUCTION
CLINICAL DISCUSSION (METHODS/TECHNIQUE)
Preparation
Accuracy
Hysterosalpingo-Contrast Sonography versus Laparoscopy
HyCoSy vs HSG
Pelvic Evaluation
Endometrial Cavity Evaluation
Ovarian Structure
Time Effectiveness
Cost Effectiveness
Complications
FUTURE DIRECTIONS AND CONTROVERSIES
3-Dimensional Technique
CONCLUSION
CHAPTER 15:
Infertility and Anxiety
ABSTRACT
INTRODUCTION
INVESTIGATION AND DIAGNOSIS-ASSOCIATED DISTRESS
Case History 1
Case History 2
Case History 3
DISTRESS RELATED TO THE TREATMENT PHASE
Case History 1
WHAT CAN WE DO ABOUT THIS?
CHAPTER 16:
Involuntary Childless Couples in Family Practice: Recommendations for Patient Management
ABSTRACT
INTRODUCTION
DEFINITION
PSYCHOLOGICAL RESPONSES TO INFERTILITY
BASIC DIAGNOSTIC AND THERAPEUTIC OPTIONS IN MALE AND FEMALE INFERTILITY
Male Infertility
Female Infertility
Treatment Options
ASSISTED REPRODUCTIVE TECHNOLOGIES (ART)
ROLE OF THE FAMILY PHYSICIAN IN INFERTILITY MANAGEMENT
Screening and Referral
Exploring the Couple's Attitudes and Motives
Guiding the Couple through Fertility Clinics
Informing the Patient about the Success and Risks of Infertility Treatment
Protecting the Patient against Premature Interventions
Supporting the Couple
Continuous Care
Situation of Men
CHAPTER 17:
Genetics of Premature Ovarian Failure
ABSTRACT
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
Abnormalities Associated with the X Chromosome
Turner's Syndrome
X Chromosome Rearrangements
Fragile X Syndrome
Autosomal Abnormalities
FSH Receptor
Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome
Galactosemia
Jaeken's Syndrome
Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy
RECENT ADVANCES
CONCLUSION
CHAPTER 18:
Ovarian Antral Follicle Count
INTRODUCTION
FOLLICULAR RECRUITMENT AND GROWTH
Growth
IMPORTANCE OF FOLLICULAR DEVELOPMENT
ANTRAL FOLLICLE COUNT
Significance of the Antral Follicle Count
CONCLUSION
CHAPTER 19:
Reaching Consensus on Aging and Infertility
INTRODUCTION
EFFECT OF AGING ON OOCYTES AND EMBRYOS
EFFECT OF AGE ON THE SPERM
AGE-RELATED CHANGES IN THE REPRODUCTIVE ORGANS
AGE AND PREGNANCY OUTCOME
CONCLUSION
CHAPTER 20:
Salpingitis Isthmica Nodosa
HISTORY AND INTRODUCTION
TUBAL SEGMENTS
PHYSIOLOGY OF THE FALLOPIAN TUBE1
Ovum Pick-up
Ovum Transport
Sperm Transport and Activation
Embryo Transport
PROXIMAL TUBAL PATHOLOGY
Obliterative Fibrosis
Chronic Tubal Inflammation
Tuberculosis
Salpingitis Isthmica Nodosa
Etiology
Mechanism of Infertility in SIN
Association with Ectopic Pregnancy
Diagnosis of SIN
Grading of SIN
Typical Patient Profile
Natural History of the Disease
Management of SIN
SUMMARY
CHAPTER 21:
Varicocele Surgery: A Shot in the Dark?
INTRODUCTION
WHY DOUBTS PERSIST ABOUT THE EFFICACY OF VARICOCELE SURGERY
IMPACT OF VARICOCELECTOMY: SUBGROUP ANALYSIS
Azoospermia
Adolescents with Varicoceles
CAN RESPONSE TO VARICOCELE REPAIR BE PREDICTED?
Size of Varicocele
Dynamic Hormonal Studies
Testicular Biopsy
DOES MEDICAL TREATMENT HELP?
IS THERE A ROLE FOR VARICOCELE SURGERY WITH THE ADVENT OF ICSI?
Cost
Downstaging the Level of ART
Facilitating ICSI in Azoospermic Men
Improving Results of ART
SURGICAL CONSIDERATIONS
Embolization versus Open Surgery
Open Surgery: High Approach versus Low Approach
Laparoscopic Ligation
Preservation of Testicular Artery
CONCLUSION
CHAPTER 22:
Environmental Effects on Fertility
INTRODUCTION
STRESS, NUTRITION AND BEHAVIORAL EFFECTS ON REPRODUCTIVE FUNCTIONS
NEUROENDOCRINE EVENTS DURING STRESS
STRESS AND FEMALE INFERTILITY
Stress and Male Infertility
Stress-Related Disorders in Men
Toxic Effects of Drugs or Chemicals on Gonadal Function
Centrally Acting Drugs
Heavy Metals
Nitrogen Sulfur Phosphorous– Containing Compounds
OESTROGENS, ENVIRONMENTAL PESTICIDES AND INFERTILITY
Xenoestrogens and Infertility
Male Infertility
Female Infertility
Pesticides and Infertility
Consumption Pattern of Pesticides in India
RISK ASSESSMENT OF ENVIRONMENTAL OESTROGENS
CURRENT UNDERSTANDING OF THE EFFECTS OF ENVIRONMENTAL OESTROGENS ON HUMANS
CONCLUSION
CHAPTER 23:
Bridging the Infertility Misinformation Gap
INTRODUCTION
What Couples Feel
Psychological Emotional Problems
MYTHS AND MISCONCEPTIONS
What can be done “Shattering Myths about Infertility”8
Counseling: What to Tell?
CONCLUSION
SECTION 2: LESSONS LEARNT IN ASSISTED REPRODUCTIVE TECHNIQUES
CHAPTER 24:
Clomiphene and Competition?
INTRODUCTION
CLOMIPHENE CITRATE
Indications
Dose, Administration and Monitoring
Contraindications
Adverse Effects
OTHER ANTIESTROGENS
INSULIN SENSITIZERS
AROMATASE INHIBITORS
Indications
DISCUSSION
CONCLUSION
CHAPTER 25:
The Role of GnRH Agonists in Infertility Management
INTRODUCTION
MODES OF GnRH-a ADMINISTRATION AND TREATMENT PROTOCOLS
Long or Desensitizing Protocol
Flare-Up Protocols
Short Protocol
Ultra Short Protocol
BENEFITS AND DRAWBACKS OF GnRH AGONIST TREATMENT IN ART
Flare-up Protocols
Long Protocol
Benefits
Drawbacks of the Long Protocol
Can LH Levels be too Low in Normogonadotropic Women Subjected to the Routine Long Protocol with GnRH Agonist Treatment for IVF?
Does Addition of LH Activity to the Stimulation Protocol Improve Reproductive Outcome in GnRH-a Down-regulated Normogonadotrophic Women?
Conclusions on the Role of LH in GnRH-a Downregulated Cycles
FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
CHAPTER 26:
Does the FSH Isoform Composition in Commercial Gonadotropin Preparations Affect Treatment Outcome?
RATIONALE
INTRODUCTION
FSH Molecule and FSH Isoforms
FSH in Circulation
In vitro Bioactivity of FSH Isoforms
In Vivo Bioactivity of FSH Isoforms
CLINICAL DISCUSSION
FSH Isoform Profile and Bioactivity of Commercial Gonadotropin Preparations
RECENT ADVANCES AND FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
CHAPTER 27:
The Role of Aromatase Inhibitors in Ovulation Induction: The Difficulties and Complications
ABSTRACT
INTRODUCTION
Disadvantages of Clomiphene Citrate
Disadvantages of Gonadotropins
AROMATASE INHIBITORS FOR OVARIAN STIMULATION
Use of Aromatase Inhibitors with Gondotropins
Difficulties and Complications
Small Experience
Adverse Effects
Future Directions and Controversies
Optimal Letrozole Dose and Duration of Treatment
Reducing Estradiol Levels to Improve the Implantation Rate
Combination with Gonadotropins
Use of Letrozole in IVF Treatment
CONCLUSION
CHAPTER 28:
Predictive Value of hCG in ART
INTRODUCTION
INCIDENCE OF BIOCHEMICAL PREGNANCIES
Predicting a Clinical Abortion
Predicting a Viable Pregnancy
Predicting a Multiple Implantation
Predicting an Ectopic Implantation
Timing of hCG Testing
CONCLUSION
CHAPTER 29:
OHSS: Current Views About Etiopathology and Management
INTRODUCTION
Description
INCIDENCE
CLASSIFICATION SYSTEMS
ETIOPATHOLOGY
Vascular Endothelial Growth Factor (VEGF)
Other Cytokines
Estrogen
Histamines
Ovarian Renin-Angiotensin System
PREVENTION
During Ovarian Stimulation
Strategies after Ovulation
Our Experience with the Prevention of OHSS in IVF
MANAGEMENT AND HOSPITALIZATION
Outpatient Management
Inpatient Management
Pain Control
Fluid Management
Thromboprophylaxis
Ongoing Pregnancy
FUTURE DIRECTIONS
CONCLUSION
CHAPTER 30:
The Role of Salpingectomy in IVF Patients with Tubal Infertility and Hydrosalpinges
INTRODUCTION
CLINICAL DISCUSSION
CASE STUDIES
Materials and Methods
Statistical Analysis
Results and Discussion
CONCLUSIONS
CHAPTER 31:
Uterine Factors: Which Should Be Remedied Before IVF?
INTRODUCTION
UTERINE LEIOMYOMATA
Prevalence
Etiology
Signs and Symptoms
Diagnosis
Uterine Leiomyomata and Fertility
Treatment
INTRAUTERINE ADHESIONS
Prevalence
Etiology
Signs and Symptoms
Diagnosis
Treatment
CONGENITAL MÜLLERIAN ANOMALIES
Effect of Müllerian Anomalies on IVF
ENDOMETRIAL POLYPS
CONCLUSION
CHAPTER 32:
Air Quality, Standards, Controls and Impact on Embryonic Development
INTRODUCTION
AMBIENT AIR
AIR POLLUTANTS
EVIDENCE-BASED MEDICINE
AIR QUALITY MONITORING
HOW TO REDUCE LEVEL OF CONTAMINANTS IN THE LABORATORY AIR?
Details of Various Instruments used to Reduce Contamination
High Efficiency Particulate Air (HEPA) Filters
CODA Tower
Laminar Air Flow Cabinets
Ultraviolet Light Irradiation
Incubators
Oil Overlay System
CONCLUSION
CHAPTER 33:
Should Non-Patient Volunteers Donate Eggs?
INTRODUCTION
SELECTION OF THE DONOR
OOCYTE SHARING IN IVF PATIENTS
NON-PATIENT DONOR
Oocyte Donation with Donor Recruited by the Patients
Voluntary Oocyte Donors
SCREENING OF THE PROSPECTIVE OOCYTE DONOR
RECRUITING A DONOR
RECIPIENTS
ETHICAL, LEGAL AND SOCIAL ISSUES
RULES FOR OOCYTE DONATION IN DIFFERENT COUNTRIES
CONCLUSION
CHAPTER 34:
Embryo Donation: A Limited Option?
INTRODUCTION
SOURCE OF DONATED EMBRYOS
RECIPIENT
LEGAL AND ETHICAL ISSUES
GUIDELINES
FUTURE COURSE
CONCLUSION
CHAPTER 35:
Is Your IVF Program Good?
INTRODUCTION
Diagnostic Evaluation of the Infertile Couple
Clinical History
Evaluation of the Male
Semen Analysis
Tests of Sperm Function
Genetic Studies
Evaluation of the Woman
Laparoscopy
Hysterosalpingography (HSG)
Test to Detect Ovulation
Ovarian Reserve Test
Clomiphene Test
Endometrial Biopsy
IgG Antibodies for Chlamydia trachomatis
Other Hormonal Tests
Ovarian Stimulation for IVF
Methods of Ovarian Stimulation
Embryology Laboratory
QA Plan
QA Goal
QA Indicators
Quality Control (QC)
Infection Control
Air-condition System
Cryopreservation of Embryos
Embryo Selection and Transfer
CONCLUSION
CHAPTER 36:
Intracytoplasmic Sperm Injection—A Step too Soon?
ABSTRACT
INTRODUCTION
IS INTRACYTOPLASMIC SPERM INJECTION SAFE?
IMPACT OF ICSI ON EMBRYONAL DEVELOPMENT
CAN WE IMPROVE THE ICSI OUTCOME?
A NEW APPROACH TO SPERM SELECTION
SPERM SELECTION AS A TOOL FOR IMPROVEMENT
Physiological Replacement for Polyvinylpyrrolidone (PVP)
Characteristics of PVP
Hyaluronate as a Replacement for PVP
CONCLUSION
CHAPTER 37:
Donor Egg IVF Programs: To Share or Not to Share?
INTRODUCTION
EGG SHARING
DONOR STIMULATION PROTOCOL
RECIPIENT ENDOMETRIAL PREPARATION PROTOCOL
PROS AND CONS OF EGG SHARING
FINANCIAL INCENTIVES IN EGG SHARING
CAUSES OF FAILURE
DOES THE RECIPIENTS' AGE MATTER?
CHAPTER 38:
Following up IVF/ICSI Children
OVERVIEW
SPERM CHARACTERISTICS RELEVANT TO ART
Methods
Results
ART AND CONGENITAL MALFORMATIONS
ART AND CHROMOSOMAL ABNORMALITIES
CONCLUSIONS AND FUTURE DIRECTIONS
CHAPTER 39:
Gamete Mix-up in Infertility Management: Ethical and Legal Concerns
INTRODUCTION
Standard Identification Format
Witnessing
Labeling
Quality Management
Auditing
ETHICAL AND LEGAL ISSUES
SECTION 3: LESSONS LEARNT IN ENDOSCOPY IN INFERTILITY
CHAPTER 40:
Endoscopy in the Evaluation and Management of ART
INTRODUCTION
LAPAROSCOPY
Laparoscopic Equipment and Avoiding Complications
Management of Adhesions
Laparoscopic Ovarian Surgery
TRANSVAGINAL HYDROLAPAROSCOPY
FALLOPOSCOPY/SALPINGOSCOPY
HYSTEROSCOPY
Resection of Polyps/myoma
Division of Intrauterine Adhesions
Division of Intrauterine Septum
RESULTS
FUTURE
CHAPTER 41:
Fertility Enhancing Endoscopic Techniques in Endometriosis
INTRODUCTION
EPIDEMIOLOGY AND RISK FACTORS
GROSS APPEARANCE
PATHOGENESIS
CLINICAL PRESENTATION
DIAGNOSIS
SCORING SYSTEM (CLASSIFICATION)
MANAGEMENT
Medical Therapy
Assisted Reproductive Technology (ART)
Surgical Therapy
Treatment for Pain
Treatment for Infertility
Surgical Technique
Endometrial Foci
Adhesions
Endometriomas
Rectovaginal Endometriotic Foci
SUMMARY
CHAPTER 42:
Office Hysteroscopy
INTRODUCTION
TARGETED HYSTEROSCOPIC BIOPSIES
SEE AND TREAT PHILOSOPHY
RECENT ADVANCES
CONCLUSION
CHAPTER 43:
The Misplaced Intrauterine Device and Endoscopy
INTRODUCTION
CLASSIFICATION OF DISPLACEMENT
HYSTEROSCOPIC SCREENING PRIOR TO IUD INSERTION
CHAPTER 44:
Hysteroscopic Resection of Myoma in Infertility
INTRODUCTION
INDICATIONS FOR SURGERY
Indication: Sterility and Infertility
Indication: Metrorrhagia
CLASSIFICATION OF SUBMUCOUS MYOMAS AND PREOPERATIVE DIAGNOSIS
PREOPERATIVE PRETREATMENT WITH GnRH ANALOGS
INFRASTRUCTURE REQUIREMENTS AND SAFETY ASPECTS
OPERATION TECHNIQUE
PREVENTION OF COMPLICATIONS
CHAPTER 45:
Uterine Septum and Fertility Enhancing Hysteroscopic Surgery
EMBRYOLOGY OF THE FEMALE GENITAL APPARATUS
EPIDEMIOLOGY AND CLINICS OF THE SEPTATE UTERUS
REPRODUCTIVE OUTCOME
DIAGNOSIS
Hysterosalpingography
Ultrasonography
Hysteroscopy
Magnetic Resonance Imaging (MRI)
TREATMENT
Surgical Treatment
RESULTS OF HYSTEROSCOPIC METROPLASTY
OUR RESULTS
CONCLUSION
CHAPTER 46:
Can We Recognize Endometriosis?
INTRODUCTION
RATIONALE
CLINICAL DISCUSSION
What Do We Recognize?
WHAT DO WE MISS?
Peritoneal Endometriosis
Ovarian Endometriosis
Rectovaginal Endometriosis
Endometriosis of Bowel and Appendix
Diaphragmatic Endometriosis
SAMPLING TECHNIQUES
IS HISTOLOGY THE GOLD STANDARD?
EMPIRICAL DIAGNOSIS AND TREATMENT
CONCLUSION
CHAPTER 47:
Endometriosis and Infertility
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION AND CASE STUDIES
RECENT ADVANCES
CONCLUSION
CHAPTER 48:
Coping with Endometriosis-Related Infertility
INTRODUCTION
THE CHALLENGE OF ENDOMETRIOSIS
THE EMOTIONAL ROLLERCOASTER
Loss and Grief
EXPECTATIONS AND CLINICAL MANAGEMENT
CONCLUSION
CHAPTER 49:
Salpingoscopy: Results and Complications
OVERVIEW
SALPINGOSCOPY
Instrumentation and Technique
Transabdominal Salpingoscopy
Transvaginal Salpingoscopy (As a Component of Fertiloscopy or Hydrolaparoscopy Only)
Methods
Findings
Results
Complications
FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
CHAPTER 50:
Endometrial Thickness: Newer Methods of Endometrial Evaluation and Current Views on the Management of Suboptimal Endometrial Pattern during Programming
INTRODUCTION
ENDOMETRIAL THICKNESS
ENDOMETRIAL PATTERN
ENDOMETRIAL VOLUME
ENDOMETRIAL BLOOD FLOW
UTERINE JUNCTIONAL ZONE CONTRACTIONS (JZC)
CAUSES OF SUBOPTIMAL ENDOMETRIUM
CAN ENDOMETRIAL RECEPTIVITY BE IMPROVED?
SUMMARY
ACKNOWLEDGMENT
CHAPTER 51:
The Adnexal Mass in Infertility
RATIONALE
INTRODUCTION
EPIDEMIOLOGY
CLINICAL DISCUSSION
Diagnosis of the Adnexal Mass
Treatment
Technique of Laparoscopic Salpingo-oophorectomy without Spill in Case of an Ovarian Cyst
SIMPLE OVARIAN CYST (CYSTOMA SIMPLEX)
MATURE TERATOMA (DERMOID CYST)
Technique
HYDROSALPINX
Technique of Laparoscopic Hydrosalpingectomy
TUBO-OVARIAN ABSCESS (TOA)
Laparoscopic Technique of Draining TOA
ADNEXAL TORSION
Treatment
Laparoscopic Technique
CASE STUDIES
Patient 1
Patient 2
CONCLUSION
CHAPTER 52:
Role of Laparoscopy in the Treatment of Endometriosis-Associated Infertility
INTRODUCTION
MECHANISMS OF ENDOMETRIOSIS-ASSOCIATED INFERTILITY
LAPAROSCOPIC TREATMENT OF ENDOMETRIOSIS-ASSOCIATED INFERTILITY AND PREGNANCY OUTCOME
Comparison of the Medical Treatment Versus Surgical Treatment
SUMMARY OF THE RESULTS
Summary of Combined Results from Meta-analysis of Adamson and Pasta
CONCLUSION
CHAPTER 53:
Laparoscopic Microsurgery
ABSTRACT
INTRODUCTION
AIMS OF MICROSURGERY
Field of View
Magnification
Avoids Tissue Drying
Minimal Handling
Less Adhesiogenic
Improved/Comparable Pregnancy Rates
EQUIPMENT FOR LAPAROSCOPIC MICROSURGERY
INDICATIONS FOR LAPAROSCOPIC MICROSURGERY BEYOND TUBAL ANASTOMOSIS
Bowel Repair
Large Bowel/Rectum: 3–0 PDS
Bladder Repair
Large Vessel
Ureteric Repair
Neosalpingostomy
Microsurgical Repair of Myoma
INDICATIONS FOR TUBAL ANASTOMOSIS
MICROSURGICAL SUTURING
Suturing in a Vertical Zone
LAPAROSCOPIC TUBOTUBAL ANASTOMOSIS
TUBOCORNUAL IMPLANTATION
OTHER TECHNIQUE OF TUBAL REPAIR
DISCUSSION
CHAPTER 54:
Adhesions and Laparoscopic Surgery for Infertility
INTRODUCTION
Adhesion Formation
Prevention of Adhesions
Adjuvants to Minimize Adhesion Formation/Reformation
Preoperative Evaluation and Preparation
INSTRUMENTATION
Modalities for Cutting
Scissors
Electrosurgical Instruments
Harmonic Scalpel
Lasers
Other Instruments
LAPAROSCOPIC ADHESIOLYSIS
MYOMECTOMY AND ADHESIONS (FIGS 54.14A TO D)
ADHESIONS AND FERTILITY ENHANCING PROCEDURES
SALPINGO-OVARIOLYSIS (FIGS 54.15 TO 54.18)
FIMBRIOPLASTY (FIG. 54.22)
SALPINGOSTOMY (FIGS 54.23 TO 54.26)
RESULTS
CHAPTER 55:
Laparoscopic Peritoneal Cavity Adhesions: Division in Infertility
OVERVIEW
METHODS AND TECHNIQUES
EQUIPMENT
Laparoscopes
Scissors
Electrosurgical Instrumentation
Harmonic Scalpel
Rectal and Vaginal Probes
CO2 Laser
SUCTION-IRRIGATORS/AQUADISSECTION
SMOKE EVACUATORS
ADHESIOLYSIS
Preoperative Preparation
Incisions
ENTEROLYSIS
ADNEXAL ADHESIOLYSIS
TUBAL SURGERY
ENDOMETRIOSIS
ADHESION PREVENTION
CONCLUSIONS
CHAPTER 56:
Laparoscopic Myomectomy in Infertility Management When, Why and How?
INTRODUCTION
COMPONENTS OF UTERINE LEIOMYOMA
ETIOLOGY OF UTERINE LEIOMYOMA
INDICATIONS FOR THE TREATMENT OF UTERINE LEIOMYOMA
MANAGEMENT OF UTERINE LEIOMYOMA
Using Lee-Huang Point in First Insertion Site
Methods of Removing the Fibroid Specimens
Suturing Methods of Uterine Incision Layers
TYPES OF LAPAROSCOPIC MYOMECTOMY
Laparoscopic Assisted Abdominal Myomectomy (LAAM)
Advantages of LAAM
Laparoscopic Assisted Vaginal Myomectomy (LAVM)
Laparoscopic Myomectomy
Outcome
WHAT TO CHOOSE FOR THE SURGERY?
CHAPTER 57:
Laparoscopic Tubal Reversal
ABSTRACT
OVERVIEW
Most Common Factors Leading to Request for Sterilization Reversals
Development of Reversal Procedures
METHODS OF TECHNIQUE
CONDITIONS OF THE REVERSAL PROCEDURE
Patient in General
Evaluation of the Fertility Potential Before Tubal Reanastomosis
Fallopian Tubes
Surgeon
Equipment
SURGICAL TECHNIQUES
Laparoscopic Technique Using Extracorporal Knott Tying
Laparoscopic Techniques Using Intracorporal Knott Tying
One-Stitch Technique
Two-Stitch Technique
Three-Stitch Technique
Four-Stitch Technique
Laparoscopically Placed Titanium Staples
Combined (Laparoscopic and Minilaparotomy) Tubal Reversal Techniques
Robotically Assisted Laparoscopic Microsurgical Tubal Reversal
Carbon Dioxide Laser Tissue Welding
RESULTS
Factors Influencing the Success of Tubal Reversal Procedures
Advantages of Laparoscopic Tubal Reversal over IVF-ET
COMPLICATIONS
Possibilities for Avoiding Complications
FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
CHAPTER 58:
Laparoscopic Radical Removal of the Uterosacral Ligaments in Endometriosis
INTRODUCTION
INNERVATION OF THE FEMALE PELVIS
TRADITIONAL SURGICAL APPROACHES
Laparotomy or Vaginal Surgery
Laparoscopic Surgery
HISTOLOGY
INDICATION(S) FOR THE REMOVAL OF THE UTEROSACRAL LIGAMENTS IN ENDOMETRIOSIS
CONTRAINDICATION(S)
RELATIVE CONTRAINDICATION(S)
PREOPERATIVE PREPARATION
General
Specific
SURGICAL TECHNIQUES
The Patient
The Team
The Equipment
Trocar Placement
Pneumoperitoneum
Trocars
Operation
Uterine Manipulation
Laparoscopic Uterine Nerve Ablation (LUNA)
Arcus Taurinus (AT)
Postoperative Management
Postoperative Follow-Up
CLINICAL STUDIES
Denervation Procedures
Debulking Procedures
FUTURE DIRECTIONS
CONTROVERSIES
CONCLUSION
CHAPTER 59:
Learning Curve and Complications Concerning Transvaginal Hydrolaparoscopy in Unexplained Infertility
ABSTRACT
OVERVIEW
HISTORY
THE TECHNIQUE
Patient Selection
Procedure
LIMITATIONS/DISADVANTAGES OF THL
LEARNING CURVE
COMPLICATIONS
Rectal Injury
Infection
False Passage
THE FUTURE
CHAPTER 60:
Thermal Energy Used in Laparoscopic Surgery in Infertile Women
ABSTRACT
ELECTRODIATHERMY
COAGULATION
MONOPOLAR VERSUS BIPOLAR HF SURGERY
LASER
Laser Systems
CO2 Laser
ND: YAG Laser
Argon Laser /KTP Laser
ULTRASONIC ENERGY
Ultrasonic Acoustic System
Laparosonic 10 mm Blades, 5 mm Blades, and Coagulating Shears (LCS) 10 mm
Nomenclature of Ultracision 5 mm Blade System
Blade Selection
Three Blade Modes
Scalpel Operation
Rationale for Ultra Cision Technology in Surgery
CLINICAL APPLICATIONS OF VARIOUS ENERGY SOURCES USED IN PRACTICE OF LAPAROSCOPIC SURGERY IN INFERTILITY
Laparoscopic Salpingo-Ovariolysis
Terminal Salpingostomy
Endometriosis
Laparoscopic Treatment of Polycystic Ovarian Syndrome
Ectopic Pregnancy
Salpingectomy
Myomectomy
SUMMARY
CHAPTER 61:
Fibroids and Infertility
ABSTRACT
INTRODUCTION
FIBROIDS AND INFERTILITY
TECHNIQUE OF LAPAROSCOPIC MYOMECTOMY
TECHNIQUE OF EXTRAPERITONEAL UTERINE ARTERY LIGATION
REMOVAL OF MYOMA
FIBROIDS AND ASSISTED REPRODUCTIVE TECHNOLOGY
HYSTEROSCOPIC EVALUATION AND TREATMENT OF SUBMUCOUS MYOMAS
TECHNIQUE OF HYSTEROSCOPIC FIBROID RESECTION
HANDY HINTS FOR LAPAROSCOPIC AND HYSTEROSCOPIC MYOMECTOMY
CONCLUSION
CHAPTER 62:
Laparoscopic Management of Ectopic Pregnancy
INTRODUCTION
EPIDEMIOLOGY OF ECTOPIC PREGNANCY
HOW TO DIAGNOSE AN ECTOPIC PREGNANCY
HOW TO TREAT AN ECTOPIC PREGNANCY
SPECIFIC SITES OF ECTOPIC PREGNANCY
Cornual Pregnancy
Treatment by Surgical Management
Laparotomy
Laparoscopy
Closure with One Stitch
Isthmic Pregnancy
Ampullary Pregnancy
FERTILITY
PERSISTING ECTOPIC PREGNANCY
CONCLUSION
CHAPTER 63:
Treatment of Intrauterine Synechiae
INTRODUCTION
TRADITIONAL AND NEW TREATMENT MODALITIES
Blind D and C
Hysteroscopic Routes and Modifications
Instrumentation and Technique
Lysis of Intrauterine Adhesions Using Gynecoradiologic Techniques
Pressure Lavage Under Ultrasound Guidance
Abdominal Approach (Laparotomy)
TREATMENT OF INTRAUTERINE ADHESION AND ASSOCIATED OBSTETRIC COMPLICATIONS
SCETION 4: FUTURE CHALLENGES
CHAPTER 64:
Tuberculosis of the Genital Tract: Current Views on Diagnosis and Management
INTRODUCTION
DEFINITION
ADVANCES IN THE DIAGNOSIS OF TUBERCULOSIS
Direct Approach
Microscopy
Culture
Radiometric BACTEC 460 TB Method
Identification of Mycobacterial Species
Detection and Identification of Mycobacteria Directly from Clinical Samples
Genotypic Methods
Phenotypic Method
Indirect Approach
Detection of Antibodies for the Diagnosis of TB
Diagnosis of Genital Tuberculosis
MANAGEMENT OF TUBERCULOSIS
Management Strategies for Tuberculosis
Nonpharmacological
Pharmacological (Table 64.1)
Treatment in Special Situations
Treatment of Relapse
Treatment of Multidrug Resistance (MDR) Tuberculosis
Latent Tuberculosis
Special Considerations in Genital Tuberculosis
CONCLUSION
CHAPTER 65:
Advances in the Diagnosis and Treatment of Endometriosis
INTRODUCTION
ADVANCES IN DIAGNOSIS OF ENDOMETRIOSIS
PAIN MAPPING OF ENDOMETRIOSIS
ADVANCES IN DIAGNOSIS OF THE PAIN ASSOCIATED WITH ENDOMETRIOSIS
ADVANCES IN THERAPY IN THE CONSCIOUS PATIENT
PHOTODIAGNOSIS OF ENDOMETRIOSIS
TREATMENT USING THE BLUE LIGHT
CONCLUSION
CHAPTER 66:
Outpatient Diagnostic and Operative Hysteroscopy: What Can We Do? How Far Can We Go?
INTRODUCTION
INSTRUMENTS AND TECHNIQUES
How Far Can We Go? What are the Indications?
CONCLUSION
CHAPTER 67:
Newer Optics Will Change the Future of Endoscopy in Infertility
INTRODUCTION AND HISTORY
STRUCTURE AND FUNCTION
STRUCTURE
FUNCTION
TELESCOPES
Laparoscopy
Hysteroscopy
Rigid Hysteroscopes
Contact Hysteroscope
Microcolpohysteroscope
Flexible Hysteroscope
Transvaginal Hydrolaparoscopy
Falloposcopy
Salpingoscopy
FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
CHAPTER 68:
Robotics in Laparoscopic Fertility Enhancing Surgery
INTRODUCTION
MATERIAL AND METHODS
Intelligent Hospital
Demographic Changes
Telesurgery
VIRTUAL REALITY TRAINING SYSTEMS
Virtual Reality Simulation
Robotic Assisted Laparoscopic Surgery
Hermes (Computer Motion)
OR1 (Karl Storz)
Alpha Image Track
EndoAssist
daVinci Surgical System
RESULTS
CONCLUSION
OVERVIEW
MATERIALS AND METHODS
Study Group
Preoperative Management
Surgical Procedure
Laparoscopic Myomectomy
Laparotomic Myomectomy
Classic Intrafascial Supracervical Hysterectomy (CISH)
Laparoscopic-Assisted Vaginal Hysterectomy (LAVH)
Outcome of Patients Treated
RESULTS
Patient Outcomes
Immediate Complications/Late Complications
Need for Subsequent Surgery
Relief of Symptoms
Fertility Outcome
Postoperative Reintegration into Working Life
FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
OVERVIEW
MATERIAL AND METHODS
Results
FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
CHAPTER 69:
Somatic Cell Haploidization: An Update
OVERVIEW
OOCYTE RECONSTRUCTION
MALE GAMETE SUBSTITUTION
TECHNIQUE AND CELL CYCLE PHASE OF SOMATIC CELL HAPLOIDIZATION
PRESENT AND FUTURE PERSPECTIVES
CURRENT PROBLEMS IN SOMATIC CELL HAPLOIDIZATION
CONCLUSION
CHAPTER 70:
Humans May Be Easier, Safer and More Effective to Clone than Animals because of a Single Genetic Difference
SUMMARY
INTRODUCTION
What is Cloning?
Technique of Cloning
APPLICATIONS OF CLONING
HUMAN CLONING
Therapeutic Human Cloning
RESULTS AND DISCUSSION
CONCLUSION
CHAPTER 71:
Continuing Medical Education and the Internet
INTRODUCTION
BACK TO BASICS: KNOWING WHAT YOU DO NOT KNOW
JUST IN TIME LEARNING
SPECIALIZATION
PHYSICIAN-TO-PATIENT LEARNING
HOW RELIABLE IS WEB-BASED INFORMATION?
INDEX
TOC
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