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Insights into Infertility Management K Jayakrishnan

CHAPTER 1:Is the Prevalence of Infertility Increasing?
- INTRODUCTION
- HOW COMMON IS INFERTILITY?
- CONCLUSION
CHAPTER 2:Female Reproductive Endocrinology—An Insight
- INTRODUCTION
- EMBRYOLOGY AND DEVELOPMENT
- FUNCTIONAL COMPONENTS
- THE MENSTRUAL CYCLE
- THE FOLLICULAR (PROLIFERATIVE) PHASE
- OVULATION
- LUTEAL (SECRETORY) PHASE
- MENOPAUSE
CHAPTER 3:Male Infertility—Evaluation and Management
- INTRODUCTION
- PHYSIOLOGY
- SEMEN AND ITS ANALYSIS
- SPERM FUNCTION TESTS
- HISTORY-TAKING AND EXAMINATION
- TREATMENT
  - Medical Management
  - Surgical Management
- INTRAUTERINE INSEMINATION
- DONOR INSEMINATION
- ASSISTED REPRODUCTIVE TECHNOLOGIES (ARTs)
- AZOOSPERMIA
- LEVEL OF EVIDENCE
- INFORMATION RESOURCES
CHAPTER 4:Recurrent Pregnancy Losses in Assisted Reproduction
- INTRODUCTION
- CAUSES OF RPL AND INFERTILITY
- PROGNOSIS
  - Investigation Protocol
- TREATMENT
- ART AS TREATMENT OF RPL
- CONCLUSION
CHAPTER 5:Evaluation of Fertilizing Ability and DNA Damage in Spermatozoa
- INTRODUCTION
- CONCLUSION
CHAPTER 6:The Role of Semen Analysis in the Investigation of Infertility
- INTRODUCTION
- SEMEN ANALYSIS
- SEMEN ANALYSIS VARIABLES AND THEIR PHYSIOLOGICAL SIGNIFICANCE
- DIAGNOSTIC USE OF SEMEN ANALYSIS—THRESHOLD VALUES
CHAPTER 7:Optimizing Ovulation Induction—Back to Basics
- INTRODUCTION
- INCIDENCE
- CLOMIPHENE CITRATE
- ROLE OF ADJUVANTS
- WEIGHT LOSS
  - Letrozole—An Aromatase Inhibitor in Anovulation
- RATIONALE FOR THE USE OF AROMATASE INHIBITORS IN ANOVULATORY WOMEN
- MECHANISM OF ACTION
- COMPARISON OF THE SUCCESS RATE OF LETROZOLE AND CLOMIPHENE CITRATE
- COMBINING GONADOTROPINS ANDAROMATASE INHIBITORS
- OUTCOME OF PREGNANCIES ACHIEVED WITH AROMATASE INHIBITORS
- CONCLUSION
CHAPTER 8:Polycystic Ovarian Disease
- INTRODUCTION
- PATHOPHYSIOLOGY
- PUBERTY AND PCOS
- MECHANISM OF ONSET OF PCOS DURING PUBERTY
- INSULIN AND THE MECHANISM OF ANOVULATION IN POLYCYSTIC OVARIAN SYNDROME
- ROLE OF HYPERINSULINEMIA IN THE PATHOGENESIS OF PCOS
- DIAGNOSIS
- APPROACH TO INFERTILITY IN A PATIENT WITH PCOS
- INSULIN SENSITIZING AGENTS
  - Metformin17
  - Mechanism of Action of Metformin
- OVULATION INDUCTION METHODS
- SURGICAL INDUCTION OF OVULATION
- SUMMARY
CHAPTER 9:Ovarian Hyperstimulation Syndrome—Newer Concepts
- INTRODUCTION
- EARLY AND LATE FORMS OF OHSS
- PATHOPHYSIOLOGY
- MANAGEMENT OF OHSS
  - Primary Prevention
  - Secondary Prevention
- CONCLUSION
CHAPTER 10:GnRH Agonist Versus GnRH Antagonist in In Vitro Fertilization and Embryo Transfer (IVF-ET)
- GnRH ANTAGONIST ADMINISTRATION
  - Fixed Versus Flexible Regimen: Which of Them is the Most Effective
- GnRH AGONIST VERSUS GnRH ANTAGONIST REGIMENS
- CONCLUSION OF META-ANALYSIS
- CONCLUSION
CHAPTER 11:Hyperprolactinemia and Infertility
- INTRODUCTION
- PROLACTIN GENE AND STRUCTURE
- PROLACTIN VARIANTS
- LACTOTROPHS
  - Extrapituitary Prolactin
- PRL RECEPTOR (PRL-R)
- REGULATION OF PROLACTIN SECRETION
- FUNCTIONS OF PROLACTIN
- PROLACTIN SECRETION AND ASSAYS
- HYPERPROLACTINEMIA
- MACROPROLACTINEMIA (BIG-BIG PROLACTIN)
- PROLACTIN-SECRETING ADENOMAS
- TREATMENT OF HYPERPROLACTINEMIA
- TREATMENT STRATEGIES
- DEFINITION OF DOPAMINE AGONIST RESISTANCE
CHAPTER 12:Poor Responder in Ovulation Induction—Management Options
- INTRODUCTION
- MANAGEMENT OPTIONS
- FSH VS hMG
- GnRH AGONIST AND ANTAGONIST
  - GnRH Agonist
- GnRH AGONIST Vs ANTAGONIST
- USE OF OC PILLS PRIOR TO OVARIAN STIMULATION
- SHORT-TERM ANDROGEN PRIMING
- OOCYTE DONATION
- CONCLUSION
CHAPTER 13:Laparoscopic Treatment of Endometriosis Focusing on Fertility Outcomes
- INTRODUCTION
- DIAGNOSIS OF ENDOMETRIOSIS
- TREATMENT
  - Preoperative and Postoperative Ovarian Suppression
  - Surgery
- DEEP INFILTRATING ENDOMETRIOSIS
- OVARIAN ENDOMETRIOMA AND ART
- GENERAL PRINCIPLES OF MANAGEMENT OF ENDOMETRIOSIS
CHAPTER 14:Current Treatment Options and Emerging Strategies for Fibroid Management
- INTRODUCTION
- PHARMACOLOGIC TREATMENT OPTIONS
- HYSTERECTOMY
- MYOMECTOMY
- MYOLYSIS AND CRYOMYOLYSIS
- MRI-GUIDED FOCUSED ULTRASOUND SURGERY
- FIBROID TREATMENT VIA UTERINE ARTERY OCCLUSION OR EMBOLIZATION
  - Uterine Artery Embolization
- LAPAROSCOPIC UTERINE ARTERY OCCLUSION
- DOPPLER-GUIDED UTERINE ARTERY OCCLUSION
- PROPOSED MECHANISM OF ACTION OF UTERINE ARTERY OCCLUSION AND EMBOLIZATION
- CONCLUSION
CHAPTER 15:Congenital Malformations of Uterus and Reproduction
- INTRODUCTION
- EMBRYOLOGY OF THE FEMALE GENITAL TRACT
- GENETICS OF MüLLERIAN ABNORMALITIES
- TECHNIQUES TO ASSESS THE FEMALE GENITAL TRACT
- CONGENITAL MALFORMATIONS OF THE UTERUS
- MANAGEMENT
CHAPTER 16:Unexplained Infertility
- STANDARD BASIC INVESTIGATIONS
- SUPPLEMENTARY (ADVANCED) INVESTIGATIONS
- ESHRE TASK FORCE ON UNEXPLAINED INFERTILITY
  - Possible Causes (Identified/Unidentified)
- DIAGNOSIS
  - Treatment
  - Selection of Treatment Option
- TREATMENT MODALITIES
- SUMMARY AND CONCLUSION
CHAPTER 17:Intrauterine Insemination—At a Glance
- INTRODUCTION
- PRE-IUI WORKUP
- VARIOUS INSEMINATION TECHNIQUES
- ARTIFICIAL INSEMINATION OF DONOR
  - Indications for Use of Donor Semen for IUI
  - Instructions to Prospective Sperm Donor
- SEMEN CRYOPRESERVATION
- TECHNIQUE OF CRYOPRESERVATION OF HUMAN SPERM
- TECHNIQUE OF HUMAN SPERM THAWING (FIGURE 7)
- IUI PROCEDURE STEPS AT A GLANCE
- 1 DAY VS 2 DAY IUI TREATMENT CYCLES
- IUI-ONE OF THE FERTILITY OPTIONS FOR HIV PATIENTS/HIV DISCORDANT COUPLE
CHAPTER 18:Enhancing IUI Success Rates
- INTRODUCTION
- CONCLUSION
CHAPTER 19:IVF and ICSI—Current Scenario
- INTRODUCTION
- INFRASTRUCTURE AND ORGANIZATION NEEDED FOR IVF AND ICSI INCLUDING QUALITY ASSURANCE
- OUTLINE OF THE DIAGNOSTIC WORK-UP PRIOR TO ART
- OVARIAN HYPERSTIMULATION
- SEMEN PREPARATION
- IVF OR ICSI
- EMBRYO TRANSFER
- LUTEAL PHASE SUPPORT
- OVARIAN HYPERSTIMULATION SYNDROME (OHSS) AS A MAJOR COMPLICATION OF ART
- MONITORING THE OUTCOME OF ASSISTED REPRODUCTION
- QUALITY ASSURANCE THROUGH DATA REPORTING
CHAPTER 20:Embryo Culture Systems
- INTRODUCTION
- PHYSIOLOGY AND METABOLISM OF THE PREIMPLANTATION EMBRYO
- pH CONTROL
- TEMPERATURE AND OSMOLARITY
- OXYGEN CONCENTRATION
- OIL
- CULTURE MEDIA
CHAPTER 21:Laboratory Set-up for IVF-ICSI
- INTRODUCTION
- LOCATION OF THE LABORATORY
- STRUCTURAL REQUIREMENTS
- LAYOUT
- INSTRUMENTS
- RECORD KEEPING
- QUALITY CONTROL
CHAPTER 22:Noninvasive Strategies for Selection of Human Oocytes and Embryos
- INTRODUCTION
- NON-INVASIVE STRATEGIES FOR SELECTION OF HUMAN OOCYTES AND EMBRYOS
- IN VITRO MATURATION OF OOCYTES
- OOCYTE VITRIFICATION
  - Results
- CONCLUSION
- ACKNOWLEDGMENT
CHAPTER 23:Fertility Preservation in Women with Gynecologic Cancer
- INTRODUCION
- FERTILITY AND OVARIAN CANCER
- FERTILITY AND CERVICAL CANCER
- FERTILITY AND ENDOMETRIAL CANCER
  - Ovarian Preservation in Endometrial Cancer
- FERTILITY AND GESTATIONAL TROPHOBLASTIC DISEASE
- PRESERVATION OF OVARIAN FUNCTION IN CANCER PATIENTS
  - Cryopreservation of Embryos/Oocytes or Ovarian Tissue
CHAPTER 24:Ectopic Pregnancy—Current Management
- INTRODUCTION
- INCIDENCE
- RISK FACTORS
- CLINICAL PRESENTATION
- DIAGNOSIS
- TREATMENT
- CURRENT EVIDENCE ON SURGERY, SYSTEMIC METHOTREXATE AND EXPECTANT MANAGEMENT IN THE TREATMENT OF TUBAL ECTOPIC PREGNANCY
- ECTOPIC PREGNANCIES IN UNUSUAL LOCATIONS
- CHANCE OF FUTURE PREGNANCY
CHAPTER 25:Gonadotropins—The Future
- INTRODUCTION
- STRUCTURE OF CORIFOLLITROPIN ALFA (ORG 36286)
  - Development of Long Acting Molecules Can be Done by
- METHOD OF ADMINISTRATION
- PHARMACOKINETICS
- EFFICACY
- FOLLICULAR GROWTH
- HORMONE LEVELS
- RESULTS WITH CORIFOLLITROPIN ALFA
  - Safety
  - Disadvantages of Corifollitropin Alfa
- CONCLUSION ON CORIFOLLITROPIN ALFA
- ADDITION OF RECOMBINANT LH TO rFSH
  - In Research
  - In Humans
- CONCLUSION
CHAPTER 26:When to Stop Infertility Treatment?
- WHEN TO STOP INFERTILITY TREATMENT?
  - Material and Methods
- WHEN SHOULD FRIENDS AND RELATIVES GIVE UP?
- WHEN SHOULD RELIGIOUS LEADERS, SOOTHSAYERS AND ASTROLOGERS GIVE UP?
- WHEN SHOULD QUACKS GIVE UP?
- WHEN SHOULD FAMILY PHYSICIAN GIVE UP?
- WHEN SHOULD OBST. GYN SPECIALIST AND ART EXPERT GIVE UP?
- HOW MANY ATTEMPTS AT INDUCTION OF OVULATION BEFORE GIVING UP?
- WHEN TO GIVE UP AFTER INTRA-UTERINE INSEMINATION?
- WHEN TO GIVE UP AFTER DONOR INSEMINATION?
- WHEN TO GIVE UP AFTER MICROTUBAL SURGERY?
- WHEN TO GIVE UP ART PROCEDURES?
- REACTIONS OF INFERTILE COUPLE WHO DISCONTINUED FURTHER TREATMENT
- WHEN TO GIVE UP FOR MEDICAL REASONS?
- EMBRYO DONATION, SURROGACY AND ADOPTION
- FUTURE HOPES FOR INFERTILE COUPLES
CHAPTER 27:The ART Bill—Its Implications
- INTRODUCTION
- SETTING UP AN ART CLINIC
- REQUIREMENTS OF AN ART CLINIC
- REGISTRATION AND ACCREDITATION
  - Which Clinics should be Registered?
  - Grant of Registration
    - Certificate of Registration
    - Renewal, Suspension or Revocation of Registration
- INFORMATION AND COUNSELING OF PATIENTS
- CONFIDENTIALITY AND CONSENT
  - Penalties

INDEX

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Chapter Notes