Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
The Art & Science of Assisted Reproductive Techniques (ART)
Rubina Merchant, Rita Basuray Das, Gautam Nand Allahbadia, Monikaa Malhotra Chawla, Goral Neeraj Gandhi, Esther Velilla Garcia
INTRODUCTION
CHAPTER 1:
Endocrinology of Assisted Reproductive Techniques
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Activin/Inhibin in Folliculogenesis and Reproduction
Anti-Müllerian Hormone
“Soft” Ovarian Stimulation
GnRH Agonist Triggering for Final Oocyte Maturation Instead of hCG
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 2:
Modern Work-up of Infertility
INTRODUCTION
CLINICAL DISCUSSION
Practical Work-up: Current Scenario
The Usual Work-up
History and Physical Examination
Evaluation of the Male
Semen Analysis
Sperm Function Tests
Evaluation of the Female
Assessment of Ovulatory Factor
Assessment of Tubal and Peritoneal Factor
Assessment of the Uterus
Evaluation of the Cervix and Vagina
Hormonal Evaluation
Clomiphene Citrate Challenge Test
Counseling
CONCLUSION
SECTION 1: STIMULATION STRATEGIES
CHAPTER 3:
Ovulation Induction with Tamoxifen Citrate
INTRODUCTION
CLINICAL DISCUSSION
Clinical Pharmacology
Pharmacokinetics and Metabolism
Mode of Action
Physiological Effects
Endocrine Effects
Effects on Bones and Lipids
Clinical Applications
Indications (Table 3.1)
Dose, Administration and Monitoring
Contraindications
Side Effects
CONCLUSION
CHAPTER 4:
Defining the Poor Ovarian Response before Controlled Ovarian Hyperstimulation
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
Chronologic Age
Basal Serum FSH
Follicular Phase Inhibin Levels
Serum Basal Estradiol Levels
Clomiphene Citrate Challenge Test
Other Dynamic Ovarian Reserve Tests
Sonographic Assessment
RECENT ADVANCES
Anti-Müllerian Hormone
CONCLUSION
CHAPTER 5:
Aromatase Inhibitors: Their Role in the Treatment of Infertility
SUMMARY
INTRODUCTION
Physiology
CLINICAL DISCUSSION
Use of Aromatase Inhibitors in Infertility
Ovulation Induction and Comparison with Clomiphene citrate
Letrozole in Women with PCOS
Letrozole in Idiopathic Infertility
Letrozole and Gonadotropin
Letrozole in Assisted Reproductive Techniques
Fertility Preservation
Aromatase Inhibitors for Male Infertility
Use of Aromatase Inhibitors for Gynecologic Conditions
Endometriosis
Myoma and Adenomyosis
Safety
CONCLUSION
CHAPTER 6:
Urinary Human FSH versus Recombinant Human FSH
INTRODUCTION
Recombinant Human FSH (r-hFSH) Preparations
r-hFSH Induces Follicular Development
CLINICAL DISCUSSION
Comparison of r-hFSH with u-hFSH in ART
Comparison of r-hFSH and Highly Purified u-hFSH
CONCLUSION
CHAPTER 7:
Stimulation Strategies for Complex IVF Patients
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Poor Responder Patients
Definition of a Poor Responder
Prediction of Response: Markers for Ovarian Aging
Different GnRH Analog Protocols
Role of LH in Multiple Follicular Stimulation for IVF
High Responder Patients
RECENT ADVANCES
CONCLUSION
CHAPTER 8:
The Dilemma of the Poor Responder: Choices before Oocyte Donation
SUMMARY
INTRODUCTION
Definition
Reasons
CLINICAL DISCUSSION
Treatment Options for Poor Responders
Choice of Stimulation Protocol and Dosage of Stimulation Medication
Natural Cycle, Modified Natural Cycle or Mild Stimulation Protocols in Poor Responders
Use of Androgens or Androgen-modulating Agents before or during Ovarian Stimulation with Gonadotropins in Poor Responders
Adjuvant Treatment with Other Substances
Further Options
CONCLUSION
CHAPTER 9:
Programming the Cycle with Oral Contraceptives: Antecedent to the Use of GnRH Antagonists
INTRODUCTION
GnRH Antagonist
CLINICAL DISCUSSION
What is the Oral Contraceptive?
Effect on Endometriosis
Effect on Bleeding Pattern
Effect on Polycystic Ovaries
Poor Responders
Good Responders
Use of COC Prior to GnRH Antagonists
Protocol
CHAPTER 10:
GnRH Agonists versus Antagonists: From Physiology to Clinical Success
INTRODUCTION
CLINICAL DISCUSSION
GnRH Antagonists
Protocols
Cycle Characteristics
Luteal Phase
In Vitro Fertilization-Embryo Transfer
Potential Benefits of GnRH Antagonists
Side Effect Profile
CONCLUSION
CHAPTER 11:
Microdose GnRH for the Stimulation of Low Responders
INTRODUCTION
Methods and Results
CLINICAL DISCUSSION
Microdose Protocols in IVF
The Poor Responder
Determination of Down-regulation
CONCLUSION
CHAPTER 12:
Role of GnRH Antagonists in the Management of Poor Responders
INTRODUCTION
Definition of Poor Responders
Assessment of the Ovarian Reserve
CLINICAL DISCUSSION
Stimulation Protocol
Synthetic GnRH and its Analogs
Use of the GnRH Analog
CONCLUSION
CHAPTER 13:
Alternative Approaches to Ovarian Stimulation and Triggering of Ovulation
INTRODUCTION
CLINICAL DISCUSSION
Ovarian Stimulation Protocols
GnRH Agonists and Gonadotropin Treatment Protocols
Indications for GnRH-a Protocols
Types of GnRH-a Protocols
Modes of GnRH-a Administration
Results with Various Protocols
GnRH Antagonists
Why do We Need Alternative Approaches to Ovarian Stimulation Protocols?
LH Supplementation in Ovarian Stimulation
Significance of the Ovarian Reserve
Poor Ovarian Responders
Alternative Approaches to Ovarian Stimulation Protocols
Delay of Gonadotropin Stimulation
Ovulation Trigger
Advantages of GnRH Agonist Trigger
Disadvantages of the GnRH Agonist Trigger
GnRH Agonist versus hCG Trigger
GnRH-a-induced LH/FSH Surge
Luteal Phase
Dual Trigger (GnRH + hCG)
Ovulation Triggering using Choriogonadotropin Alfa
Recombinant LH to Trigger Final Oocyte Maturation
RECENT ADVANCES
Ovarian Pigment Epithelium Derived Factor
Kisspeptins for Triggering Final Oocyte Maturation
Vitrification
Alternative Stimulation Approaches in Poor Responders
Mild Stimulation Protocols
CONCLUSION
CHAPTER 14:
Role of LH in Stimulation Protocols for ART
INTRODUCTION
CLINICAL DISCUSSION
Measures taken to Lower Circulating Levels of LH and Characteristics of Exogenously Administered Gonadotropins
Is the LH Content in hMG Preparations Detrimental to the Outcome of IVF?
Negative Effects of Decreased Circulating Levels of LH during Ovarian Stimulation
CONCLUSION
CHAPTER 15:
Role of hMG-HP in Stimulated Cycles for ART
INTRODUCTION
The Rationale of Introducing Highly Purified hMG
CLINICAL DISCUSSION
Advantages of hMG-HP
Efficacy of hMG-HP
Clinical Outcomes with hMG-HP versus r-FSH
Cost Benefits of hMG-HP
Role of LH in Ovulation Induction
Role of LH in Patients with Hypogonadotropic Hypogonadism
Role of LH in Normo-ovulatory Women
Role of LH in Poor Responders
The Significance and Dose of LH Supplementation
CONCLUSION
CHAPTER 16:
Protocol for the Good Egg
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
Evaluating the Ovarian Reserve
Pre-IVF Stimulation Priming
Oral Contraceptive Pills
Estrogen Priming (Fig. 16.2)
Testosterone Priming (Fig. 16.3)
IVF Stimulation
Choosing a GnRH Agonist versus Antagonist
Choosing a Gonadotropin
Adding an Oral Agent to the IVF Cycle
Gonadotropin Start Day
Adding Growth Hormone
Adding LH
Progesterone Rise in the Follicular Phase before the Ovulation Trigger
Choosing an Ovulation Trigger
In Vitro Fertilization-Embryo Transfer
Adjuvant Therapies
Vitamins
CASE STUDIES (WHERE APPLICABLE)
RECENT ADVANCES
CONCLUSION
CHAPTER 17:
The Value of Individualized Ovarian Stimulation Protocols
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
What is the Optimal Number of Eggs?
Markers of Ovarian Function
Hormonal Markers
Early Follicular Phase FSH and Estradiol
Inhibin B
Anti-Müllerian Hormone
Ultrasound Markers
Antral Follicle Count (AFC)
Ovarian Volume and Doppler Flow Indices
Dynamic Tests of Ovarian Response
Models of Multiple Markers
Stimulation Protocols
Protocols
Drug Dose
CONCLUSION
CHAPTER 18:
Luteal Phase Support
INTRODUCTION
CLINICAL DISCUSSION
Physiology and Morphology of the Endometrium and its Correlation in Different Phases of the Menstrual Cycle
Corpus Luteum and its Function
Assessment of Endometrial Maturity
Medications for Luteal Phase Support
CONCLUSION
CHAPTER 19:
Severe OHSS: A Critical Care Physician's Point of View
INTRODUCTION
CLINICAL DISCUSSION
Incidence
Pathogenesis
Clinical Features of Severe OHSS
Principles of Management
CONCLUSION
CHAPTER 20:
Protocols for Reducing the OHSS Risk and their Success
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Strategies
Prediction
Low Dose Protocols/Minimal Stimulation
GnRH Antagonist Protocols
Lowering the hCG Dose
Eliminating hCG
Coasting
Alternative Agents for Triggering Ovulation
Other Strategies
GnRH Antagonist Salvage
Cycle Cancellation
In Vitro Maturation47
Insulin-sensitizing Agents48
Intravenous Albumin
Hydroxyethyl Starch
Dopamine Antagonists
RECENT ADVANCES IN REDUCTION OF OHSS
CONCLUSION
CHAPTER 21:
Ovulation Induction: A Surgical Approach
INTRODUCTION
CLINICAL DISCUSSION
Bilateral Ovarian Wedge Resection: History of an Old Technique
Mechanisms of Action: Theory
Posterior Endocrine Alterations
Adverse Iatrogenic Events
Mechanisms to Minimize Adhesions
Laparoscopic Techniques: Laparoscopic Ovarian Drilling (Figs 21.1A and B)
Effect of Monopolar LOD on the Embryo Quality and Implantation Rate in PCOS Patients Undergoing IVF
Postoperative Endocrine Alterations
Intra-abdominal Adhesion Formation and Ovarian Atrophy
Abortion Rates
Indications
Indications that are Not Recommended
A New Surgical Treatment: Transvaginal Ovarian Drilling
Materials and Methods
Results
Conclusion
Comparison with Medical Treatment Options for PCOS
Conventional Gonadotropin Therapy
Pulsatile GnRH Therapy
Low-dose GnRH Agonist: Gonadotropin Therapy
FUTURE DEVELOPMENTS
CONCLUSION
SECTION 2: POLYCYSTIC OVARY SYNDROME
CHAPTER 22:
Polycystic Ovary Syndrome: An Update
INTRODUCTION
Historical Background
CLINICAL DISCUSSION
PCOS Phenotype
PCOS Prevalence
Pathophysiology of PCOS
Clinical Complex of PCOS
Cosmetic Disorders of PCOS
Therapies for Cosmetic Disorders of PCOS
Reproductive Disorders of PCOS
Therapies for Reproductive Disorders of PCOS
Metabolic Disorders of PCOS
Therapies for Metabolic Disorders of PCOS
CONCLUSION
CHAPTER 23:
Polycystic Ovary Syndrome: Genetics and Health Consequences
INTRODUCTION
History and Background
Definition
Epidemiology
Morphology
Endocrine Findings
Obesity, Hyperinsulinemia and Hyperandrogenism
Insulin resistance, Hyperinsulinemia and Hyperandrogenism
CLINICAL DISCUSSION
Genetics of Polycystic Ovary Syndrome
Familial Studies
Genetic Basis
Long-term Health Consequences and Implications of Genetics
Fertility Problems
Non-fertility Related Problems
CONCLUSION
SECTION 3: ART PROCEDURES
CHAPTER 24:
Vaginal Oocyte Retrieval
INTRODUCTION
Disadvantages of Laparotomic and Laparoscopic Oocyte Retrieval
Ultrasound-guided Needle Aspiration
CLINICAL DISCUSSION
Transvaginal Oocyte Aspiration
Advantages of Transvaginal Oocyte Aspiration
Technique of Transvaginal Ultrasound-guided Oocyte Aspiration
Timing of Oocyte Retrieval
Precautions
Complications
CONCLUSION
CHAPTER 25:
Gamete Intrafallopian Transfer
INTRODUCTION
CLINICAL DISCUSSION
Indications
Technique
Laparoscopic GIFT
Transcervical GIFT
RESULTS
Factors that may Influence the Results
Quality and Number of Oocytes
Age
Cause of Infertility
Complications
Complications of Ovarian Stimulation: ovarian Hyperstimulation Syndrome (OHSS)
Complications of Ultrasound-guided Oocyte Retrieval
Complications of Laparoscopy
Ectopic and Heterotopic Pregnancy
FUTURE DIRECTIONS AND CONTROVERSIES
CHAPTER 26:
Zygote Intrafallopian Tube Transfer: Patient Selection is the Key to Beneficial Utilization
INTRODUCTION
CLINICAL DISCUSSION
The ZIFT Technique
Outcome Data
Patient Selection
CONCLUSION
CHAPTER 27:
Fallopian Tube Sperm Perfusion
INTRODUCTION
CLINICAL DISCUSSION
Fallopian Tube Sperm Perfusion
Insemination Devices
Our Technique of FSP
Double FSP versus Single FSP
Intrauterine Insemination versus Fallopian Tube Sperm Perfusion
Direct Intraperitoneal Insemination
CONCLUSION
CHAPTER 28:
IVF versus ICSI: How Do You Choose?
INTRODUCTION
CLINICAL DISCUSSION
ICSI and Embryo Development
Indications for ICSI
Male Factor Infertility
Non-male Infertility Reasons
CONCLUSION
CHAPTER 29:
Use of Lasers in ART: Clinical Applications and Potential Research Tools
INTRODUCTION
CLINICAL DISCUSSION
Lasers and Delivery Systems Available for Micromanipulation
Sperm Micromanipulation
Oocyte Micromanipulation
Laser Zona Drilling (LZD)
Laser Assisted Hatching (LAH)
Blastomere Biopsy and Preimplantation Genetic Diagnosis
CONCLUSION
CHAPTER 30:
Optimizing Embryo Transfer: Can We Do Better?
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Pre-Embryo Transfer
Evaluating the Cervico-uterine Axis and Uterine Cavity
Embryo Transfer
Patient Instructions
Optimal Day for Embryo Transfer
Ultasound-guided Embryo Transfer
Cervical Preparation
Types of Embryo Transfer Catheters
Embryo Transfer Media
Catheter Loading
Site of ET: Placement of Catheter Tip
Transfer Speed
Difficult Embryo Transfer
Alternatives to the Transcervical Route
Embryo Transfer Catheter Withdrawal
Uterine Contractions
Embryo Expulsion
Embryo Retention
The Embryo Transfer Procedure
Post-Embryo Transfer
Antibiotics
Rest and Travel After ET
Luteal Support
Sexual Intercourse
CONCLUSION
CHAPTER 31:
Single Embryo Transfer: Possibilities and Limitations
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Does the Available Evidence Support Judicious SET as a Valuable Tool to Minimize Multiple Pregnancies?
Cost-effectiveness of SET
Indications for SET
Medical SET (mSET)
Can there be Any Exclusion to SET?
Challenges with SET
Clinician Education
Patient Awareness and Education
Financial Considerations
Improved Embryo Selection
Optimizing Cryopreservation
CONCLUSION
CHAPTER 32:
Blastocyst Transfer: One Step Further in the Quest for the Magic Bullet
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
Implantation Rates and Multiple Pregnancies following Blastocyst Transfer
Monozygotic Twins
New Technologies
CONCLUSION
CHAPTER 33:
Native Assessment of Sperm Ultramorphology: Clinical Application and Efficacy
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Patient Selection
Semen Evaluation and Preparation
Sperm Selection for IMSI
Microinjection
Embryo Culture
Statistical Methods
RESULTS
CLINICAL DISCUSSION
CONCLUSION
SECTION 4: LABORATORY ISSUES
CHAPTER 34:
Setting up an ART Laboratory
INTRODUCTION
CLINICAL DISCUSSION
Feasibility Study
Technical Study
Marketing Study
Legal Study
Financial Study
Laboratory Design
Air Quality
Space Design
Building Materials
Preparing the Laboratory for Work
Equipment
Staffing and Direction
Infection Control
Standard Operating Procedures
Supplies
Quality Control and Quality Assurance
Failure Mode and Effect Analysis
Malpractice Insurance
CONCLUSION
CHAPTER 35:
Semen Analysis for Clinical Interpretation
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Inherent Ambiguities
Further Testing
Repeat Testing
Logical Framework
Interpretation through Question and Answer
Can Sperm Reach the Fertilization Site?
Can the Sperm Fertilize the Egg?
Are Immunological Factors Suspected?
Do Chemical Components Need to be Assessed?
Routine Semen Analysis
Macroscopic Analysis
Microscopic Analysis
Sperm Movement through the Cervical Mucus
Sperm Mucus Penetration Test
Specialized Semen Analysis
Hypo-osmotic Swelling Assay
Sperm Acrosome Reaction Assay
Zona Binding Assay
Sperm Penetration Assay
Antisperm Antibody (ASAB) Test
Antisperm Antibody Assays
Semen Chemistry
Prostatic Contribution Analysis
Seminal Vesicular Contribution Analysis
Epididymal Contribution Analysis
Seminal Plasma pH Analysis
Novel Testing: DNA Fragmentation Testing
Sperm Maturity Testing
CONCLUSION
CHAPTER 36:
Modern Evaluation of Sperm: Clinical Application of the 5th Edition WHO Manual for Processing and Examining Semen
INTRODUCTION
History and Background
CLINICAL DISCUSSION
Pre-collection Steps
Specimen Collection
Ejaculation
Physical Parameters
Coagulation
Viscosity
Color
Odor
Volume
pH
Microscopic Evaluation
Sperm Motility
Sperm Agglutination
Sperm Concentration
Sperm Morphology
Sperm Vitality Test
Antisperm Antibodies Assay
Other Cells in Semen
Quality Control in the Andrology Laboratory
CONCLUSION
CHAPTER 37:
Fundamentals of Sperm Processing Techniques
SUMMARY
INTRODUCTION
Nature's Own Sperm Processing Clinic
Mimicry and Improvement
CLINICAL DISCUSSION
Evolution of Laboratory Sperm Processing
Sperm Processing
Centrifugation
Viscosity Reduction
Sperm Migration Method
Swim-up Procedure
Sperm Swim-up Procedure(Without Centrifugation)
Swim-down Procedure
Density Gradient Centrifugation Method
Colloidal Silica-based Density Gradient
Iodixanol-based Density Gradient
Column Adherence Procedure
Sephadex Column Filtration Procedure
Glass Wool Column Filter Procedure
Advanced Sperm Selection Procedures for ICSI
Live Sperm Morphology
Sperm Membrane Maturity
Non-Apoptotic Sperm Selection
Sperm Selection based on Surface Charge
CONCLUSION
CHAPTER 38:
Sperm Separation Techniques: Comparison and Evaluation of Methods and Gradient Products–Then and Now
INTRODUCTION
CLINICAL DISCUSSION
Sperm Separation Techniques
Density Gradient versus Swim-up
Gradient versus Glass Wool and Sephadex
Gradient versus Optiprep, Ixaprep and Accudenz
Silane-coated Silica-based Gradients:Past and Present
CONCLUSION
CHAPTER 39:
Prediction of ART Outcome in Male Factor Infertility Patients by a New Semen Quality Score
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Developing an Overall Semen Score
Patient Selection in the Evaluation of Semen Scores
Assessment of Semen Variables
Measurement of Sperm Morphology
Statistical Model for Calculating the Semen Scores
Calculation of the IUI-Semen Pregnancy Score
Semen Quality and Relative Quality as Measures of Semen Score
Relationship of SQ and RQ Scores with IUI Pregnancy Rates
Relationship of IUI-SPS with IUI Pregnancy Rates
Relationship between Female Characteristics and Pregnancy Rate
Significance of SQ and RQ as Novel Semen Scores
Computer Assisted Semen Analyzer-derived versus Conventional Semen Scores
Information Provided by SQ and RQ Scores
Controversy over Semen Quality and ART Outcome
The Role of SQ and RQ Scores and the IUI-Semen Pregnancy Score
Information Provided by IUI-SPS and Relationship with Pregnancy
CONCLUSION
CHAPTER 40:
Why Should We Assess Oocyte and Embryo Morphology?
INTRODUCTION
CLINICAL DISCUSSION
Morphology Assessment: How and When?
The Follicle
The Oocyte
The Pronuclear Embryo (Zygote)
The Developing Embryo
The Blastocyst
Morphology Assessment Time Lapse Imaging
CONCLUSION
CHAPTER 41:
Embryo Screening: Invasive versus Non-invasive
INTRODUCTION
CLINICAL DISCUSSION
Classical Evaluation versus Time-lapse Scoring
Early Cleavage
Cell Number and Rate of Division
Inequalities in the Sizes of Blastomeres
Visualization of the Nucleus and the Level of Multinucleation
Percentage and Type of Cell Fragmentation
Blastocyst Morphology
Blastocele Expansion
Zona Pellucida
Trophectoderm
Time-lapse Imaging
Advantages of Time-lapse Systems
Studies Focused on Embryo Kinetics
Early Development Markers of Blastocyst Formation
Limitations of Time-lapse Systems
Other Non-invasive Methods
Respiration Rate
Metabolic Markers
Investigating the Secretome
Investigating the Metabolome
Preimplantation Genetic Screening for Embryo Selection: The Invasive Approach
Preimplantation Genetic Screening
Clinical Indications for PGS
Good Prognosis Patients
CONCLUSION
CHAPTER 42:
Benefits and Drawbacks of Extended Embryo Culture
SUMMARY
INTRODUCTION
History of Blastocyst Transfer
CLINICAL DISCUSSION
Rationale of Blastocyst Culture
METHODS AND RESULTS
Complications
Monozygotic Twinning
Blastocyst Registry
CONCLUSION
CHAPTER 43:
Really Just how Important is the Level of Lighting in the IVF Laboratory for Embryo Development?
INTRODUCTION
CLINICAL DISCUSSION
The Effect of Light: Lessons from Cell Culture
Effect of Light on Oocytes and Embryos
Animal Studies
Human Studies
The Possible Damaging Effect of Light on Mammalian Cells
Protection against ROS
Minimizing the Effect of Light
CONCLUSION
CHAPTER 44:
Improving Air Quality in an IVF Laboratory
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Air Quality and Human Reproduction
Impact of Improved Air Quality
European Union Tissues and Cells Directive (EUTCD, 2004)
Particle Filtration
Microbial Contamination
Volatile Organic Compound Filtration
The Concept of a “Cleanroom”
Recommendations
Ideal Embryology Laboratory
Air-handling Ventilation and Filtration System
Mechanisms to Reduce Contamination
Tackling Volatile Organic Compounds
Debate
Scientific Evidence
Cost-effectiveness
CONCLUSION
CHAPTER 45:
The Mouse Embryo Bioassay: Is it the “Gold Standard” for Quality Control Testing in the IVF Laboratory?
INTRODUCTION
CLINICAL DISCUSSION
Why do Bioassay Testing? Because We Have To!
Types of Bioassays
Sperm Motility Assay
Cell Lines
The Mouse Embryo
The Two-cell Embryo
The One-cell Embryo
The Mouse Embryo Bioassay
Important Considerations
General Comments on the Mouse Bioassay
External Testing
Internal Testing
CONCLUSION
CHAPTER 46:
In Vitro Oocyte Maturation
INTRODUCTION
CLINICAL DISCUSSION
CONCLUSION
CHAPTER 47:
In Vitro Maturation: Future Clinical Applications
SUMMARY
METHODS AND TECHNIQUES
Patients
Oocyte Recovery
In Vitro Maturation
In Vitro Fertilization (IVF), In Vitro Development (IVD), and Embryo Transfer (ET)
Endometrial Preparation
RESULTS
IVM in Patients with Various Infertility Factors
Effect of hCG-priming in IVM Cycles
The Experience of hCG-primed IVM Cycles
Application of IVM Program for the Prevention of OHSS in COH Cycles
Complications
FUTURE DIRECTIONS AND CONTROVERSIES
CONCLUSION
CHAPTER 48:
Oxidative Stress and DNA Damage in Human Sperm: The Cleveland Clinic Story
SUMMARY
INTRODUCTION
RATIONALE
ROS and Sperm Physiology
CLINICAL DISCUSSION
Cellular Origin of ROS in Human Semen
ROS Production by Spermatozoa
ROS Production by Leukocytes
ROS Scavenging Strategies
Prevention
Interception
Repair
The Concept of Oxidative Stress
Mechanisms of ROS Toxicity
Lipid Peroxidation
Initiation Stage
Propagation Stage
Impairment of Sperm Motility
Sperm Nuclear DNA Damage
Origin of DNA Damage in Spermatozoa
Complications of Sperm Nuclear DNA Damage
Contributions of the Cleveland Clinic
Mechanism of Seminal OS
Assessment of OS Status
Measurement of ROS (Fig. 48.3)
Measurement of TAC (Figs 48.4A and B)
ROS-TAC Score: A New Development in Field of OS
Quality Control of OS Indices (ROS and TAC)
Clinical Significance of the Assessment of Seminal OS
ROS in Neat (Raw) Semen:An Accurate and Reliable Test for OS
Strategies to Reduce Seminal OS
FUTURE DIRECTIONS
CHAPTER 49:
Quality Management in an Assisted Reproductive Therapy Environment
INTRODUCTION
CLINICAL DISCUSSION
Risk Assessment within the ART Environment
Risk Classification
Consent Form
Unique Patient Identification
Gene Pool Restriction
Non-specific Requirements of a Quality Management System
Policy
Training
Legal Issues
Internal Audit System
Management Review
Customer Satisfaction
Development of a Quality Management System
CHAPTER 50:
Quality Assurance and Risk Management in an ART Program
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
The Concept of Quality
Definition of Quality Control
Risk Assessment
Quality Control
Quality Assurance
Quality Improvement
Risk Management
Quality Assessment
Problem Management
International Standard and Accreditation for IVF Centers
Total Quality Management
International Standards
India
Australia and New Zealand
Europe
United States
Middle East
Essential Requirements for an ART Clinic
Essential Qualifications of an ART Team
Quality Control in the IVF Laboratory
The IVF Laboratory
Location
Work Stations and Laboratory Design
Air Quality in the Laboratory
Incubators
Temperature
Equipment and Consumables
Culture Media
Embryologists: Training and Accreditation
Standard Operating Procedures and Documentation
Audits
CONCLUSION
SECTION 5: CONTEMPORARY THOUGHTS
CHAPTER 51:
How to Improve Success Rates in IVF
SUMMARY
INTRODUCTION
Patient Factor
Laboratory Factor
The Physician Factor
CLINICAL DISCUSSION
Superovulation
Pure FSH
Recombinant Gonadotropins
GnRH Antagonists
Combination Protocols
Patient-friendly Protocols (Gentle Stimulation)
Techniques to Improve Embryo Quality
Micromanipulation
Using the Embryoscope for Embryo Selection
Preimplantation Genetic Diagnosis
Embryo Cryopreservation using Vitrification
Role of the Endometrium
The Embryo Transfer Technique
CONCLUSION
CHAPTER 52:
Current Immunological Assays: Are they Enough to Uncover the Supposed Immune Causes for Assisted Reproduction Failure?
SUMMARY
INTRODUCTION
Antiphospholipid Antibodies
Antithyroid Antibodies
Reproductive Peripheral Blood Immunophenotyping
Antinuclear Antibodies and Antiovarian Antibodies
Human Serum Embryotoxicity
Antisperm Antibodies
CONCLUSION
CHAPTER 53:
Endometriosis and ART
INTRODUCTION
CLINICAL DISCUSSION
Endometriosis and Infertility
Endometriosis and ART
GnRH Analog Therapy in ART Cycles in Women with Endometriosis
Folliculogenesis and Ovulation in Endometriosis
Embryo Quality and Uterine Receptivity in Endometriosis
CONCLUSION
CHAPTER 54:
Infertility: Is there Success after Forty?
INTRODUCTION
CLINICAL DISCUSSION
Ovarian Reserve Testing
Basal FSH/Estradiol
Anti-Müllerian Hormone
Ultrasound Evaluation of Antral Follicle Count
Other Tests for Ovarian Reserve
Treatment of the Older Patient
Clomiphene Citrate with Intrauterine Insemination (CC-IUI)
Gonadotropins with IUI (INJ-IUI)
Assisted Reproductive Techniques (IVF, GIFT)
Stimulation Protocols
Other Adjuvant Treatments
Oocyte Donation
CONCLUSION
CHAPTER 55:
Inheritance of Infertility
INTRODUCTION
CLINICAL DISCUSSION
Genetic Abnormalities in the Female Infertile Population
X-Chromosome Abnormalities
XX-gonadal Dysgenesis
Familial Premature Ovarian Failure
Müllerian Aplasia
Hand-foot Genital Syndrome
Leiomyomata
Endometriosis
Polycystic Ovary Syndrome
Genetic Abnormalities in the Male Infertile Population
Genes Involved in Sex Determination
DSS: X-linked Switch Between Female and Male Development
Autosomal Genes Involved in Sex Determination
Genes Involved in Spermatogenic Disruption
Deletions of Y-Chromosome
Genes in the AZFa, AZFb and AZFc Families
DAZ Gene Family
RNA-binding Motif Gene Family
Cystic Fibrosis Transmembrane Conductance Regulator Gene
CHAPTER 56:
Ovarian Tissue Preservation in Cancerous Patients: State of the Art
INTRODUCTION
CLINICAL DISCUSSION
Chemotherapy-associated Gonadotoxicity
Effect of Dose Intensity, Cumulative Dose and Route of Administration on the Incidence of POF
Other Alternatives for Fertility Preservation
Cryopreservation of “Mature” Metaphase II Oocytes
Cryopreservation of Fertilized Oocytes after In Vitro Fertilization
Transplantation of Ovarian Tissue
Cryopreservation of Ovarian Tissue
Autotransplantation
Xenotransplantation
In Vitro Maturation (IVM)
Chemotherapy and GnRH-a Co-treatment
What are the Reasons for Discrepancy between Various Studies?
Inhibin Measurements
FUTURE ENDEAVORS
ACKNOWLEDGMENTS
CHAPTER 57:
Molecular Biology Applied to ART
INTRODUCTION
CLINICAL DISCUSSION
Preimplantation Genetic Diagnostic
PGD for Aneuploidy Screening (PGD-AS)
24 Chromosome PGS by Array-CGH
PGD for Chromosome Translocation
PGS of Chromosomes by Array-SNP
PGD for Single Gene Disorders
PGD for HLA Matching
PGD for Inherited Predisposition to Cancer
PGD for Late Onset Disorders
Male Infertility
Fluorescence in situ Hybridization for Aneuploidy in Human Sperm
Sperm DNA Fragmentation
Single Cell Gel Electrophoresis (SCGE) or Comet Assay
Female Infertility
CONCLUSION
CHAPTER 58:
Women Seeking IVF in Genital Tuberculosis: A Developing Country's Perspective
INTRODUCTION
Epidemiology
Pathogenesis
Pathology
Fallopian Tubes
Uterus
Ovaries
Peritoneum
Cervix
Vagina and Vulva
CLINICAL DISCUSSION
Genital Tuberculosis and Infertility
Tubal Factors
Defective Ovarian Function due to Tubo-ovarian Mass Formation, Adhesions, Anovulation, and Poor Ovarian Reserve28–30
Endometrial Damage in TB30,32
Diagnosis
Treatment
Medical Treatment
Directly Observed Treatment Short Course (DOTS) Strategy
Monitoring
Surgical Treatment
In Vitro Fertilization and Embryo Transfer (IVF-ET) in Genital TB
Gestational Surrogacy in Genital TB
NEW TUBERCULOSIS RESEARCH
CONCLUSION
CHAPTER 59:
Assisted Reproductive Techniques in HIV Serodiscordant Couples: Practice, Prognosis and Future Prospects
INTRODUCTION
CLINICAL DISCUSSION
HIV, Gametes and Fertility
Assisted Reproductive Techniquesfor Serodiscordant Fertile Couples
Assisted Reproduction for InfertileSerodiscordant Couples
Procedure for Handling Gametesfrom HIV Serodiscordant Couples
Assisted Reproductive Techniques, Pregnancy and HIV
CONCLUSION
CHAPTER 60:
Obstetric Outcomes and Congenital Abnormalities after IVF, ICSI and IVM
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Course of Pregnancy
Risk for Miscarriage
Pregnancy Complications
Twin Pregnancies
Vanishing Twin
Risks for Abnormalities
Risk for Congenital Abnormalities
Risk for Chromosomal Abnormalities
Imprinting Disorders
Obstetric Outcome
Outcomes of IVF-and ICSI-Conceived Children
Long-term Development of Children
Outcome after In Vitro Maturation (IVM)
CONCLUSION
SECTION 6: THIRD PARTY REPRODUCTION
CHAPTER 61:
Oocyte Donation
INTRODUCTION
CLINICAL DISCUSSION
Pretreatment Counseling
Recipients of Oocytes: Indications
Broad Categorization
Detailed Categorization
Source of Oocyte Donors
Ideal Oocyte Donors
Counseling of Unsuitable Donors
Investigations for Donors
Benefits to Donors
Investigations and Prerequisites for Oocyte Recipients
Medication for Recipients
Medication for Oocyte Donors
Success of IVF with Oocyte Donation
CONCLUSION
CHAPTER 62:
Oocyte Sharing Programs
INTRODUCTION
CLINICAL DISCUSSION
Non-patient Oocyte Donation
Concerns with Non-patient Oocyte Donation
Shared Oocyte Donation Involving IVF Patient Donors
Concerns with Shared Oocyte Donation
Compensation
Role of Counseling
Technical Minutiae
Challenges with Egg Sharing
RECENT ADVANCES
International Egg Sharing
Cryopreservation
CONCLUSION
CHAPTER 63:
Gestational Surrogacy
INTRODUCTION
CLINICAL DISCUSSION
Legal and Ethical Isssues Surrounding Surrogacy
Psychodynamic Issues
Psychological Screening
Screening the Prospective Parents
Selecting the Surrogate
The Team Approach
Pregnancy
Delivery and Postpartum
Counseling
CONCLUSION
CHAPTER 64:
Germinal Stem Cells:Culture and Replication
INTRODUCTION
Tissue Culture Materials and Routine Procedures
Equipment
Tissue Culture Media and Solutions
Preparation of Feeder Cells
Derivation and Culture of Human Embryonic Germ Cells
Expansion of Pluripotent Stem Cells into Permanent Cell Lines
Maintenance of Pluripotent Cell Lines
Subculture of PS Cells
Freezing and Thawing of Pluripotent Cells
Freezing Cells
Thawing Cells
In Vitro Differentiation in Pluripotent Cells
Stem Cell Markers
Identification of Stem Cell Markers
Karyotype Analysis
Collection of Mitotic Cells
Preparation of Mitotic Spreads
G-banding Analysis
CONCLUSION
CHAPTER 65:
Cytoplasmic and Nuclear Transfer: New Life for an Old Egg?
INTRODUCTION
CLINICAL DISCUSSION
Sexual Reproduction
Safety Mechanism
Mitochondria and Development
Mitochondrial DNA
Mitochondrial Genetics
Disorders of Mitochondrial Metabolism
Role of Mitochondria in Atresia
Mitochondria and Aging
Clinical use of Cytoplasmic Transfer
Nuclear Transfer
CONCLUSION
SECTION 7: IMPLANTATION
CHAPTER 66:
The Endometrium and Implantation
INTRODUCTION
CLINICAL DISCUSSION
Molecular Markers of Endometrial Receptivity
Steroid Hormones
MUC1
Cytokines
Cadherins
Adhesion Molecules
Heat Shock Proteins
Calcitonin
Hox Genes
Embryonic Regulation of Endometrial Receptivity in Humans
Embryonic Regulation of Human Endometrial Epithelial Cell Cytoskeleton
Embryonic Regulation of Chemokines in Human Endometrial Epithelial Cells
Embryonic Regulation of Adhesion and Anti-adhesion Molecules in Human Endometrial and Epithelial Cells
The Blastocyst Regulates Apoptosis of Endometrial Epithelial Cells
Clinical Implications
CONCLUSION
CHAPTER 67:
Modulators of Endometrial Receptivity: A Molecular Symphony
SUMMARY
CLINICAL DISCUSSION
The Broad Perspective
Setting the Stage: The Overture
Apposition
Adhesion
Penetration
Invasion
Vascular Breaching
Placental Formation
The Players at the Molecular Level
Calcitonin
Chemokines
Epidermal Growth Factor (EGF)
Ezrin, Radixin and Moesin
Integrins
Interleukin-1 (IL-1)
Leukemia Inhibitory Factor (LIF)
Mucins (MUC)
Prostaglandins (PGs) and COX Enzymes
Proteinases
Improving the Outcome
Embryo Culture
Timing of Embryo Transfer
pH and Gas Phase
Dilution Factor
CONCLUSION
CHAPTER 68:
Endometrial Preparation for Patients Undergoing Frozen-thawed Embryo Transfer Cycles
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Synchronization
Endometrial Preparation Protocols
Natural Cycle
Hormone Replacement using Estrogen and Progesterone
Hormone Replacement using GnRH-a followed by Estrogen and Progesterone
Ovulation Induction
CONCLUSION
CHAPTER 69:
Pathophysiology of Implantation Failure in IVF
INTRODUCTION
CLINICAL DISCUSSION
Apposition and Attachment:Role of the Endometrium
Role of Pinopodes
Adhesion Molecules in the Uterine Epithelium
Mucins
Integrins
Role of Growth Factors and Cytokines
Leukemia Inhibitory Factor
Interleukin-1
Placental Invasion: Role of the Endometrium
Broad-spectrum Protease Inhibitors
Insulin-like Growth Factor Binding Protein-1
Role of Macrophages, T Cells and Natural Killer Cells in the Endometrium
Effect of Ovarian Stimulation and Embryo Development on Implantation
Significance of the Embryo Replacement Technique
CONCLUSION
CHAPTER 70:
Recent Advances in the Understanding of the Immunology of Reproductive Failure
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
Immune Factors
Human Leukocyte Antigen
T Lymphocytes
Natural Killer Cells
Macrophages
Chemokines
Emerging Immunomodulatory Molecules
Autoimmune Antibodies
Antimicrobial Peptides
Management
Aspirin and Heparin
Steroids
Plasma Exchange (Plasmapheresis)
Paternal Leukocyte Injection
Intravenous Immunoglobulin Infusion
Anti-TNF-a Drugs
Intralipid
Human Leukocyte Antigen-G
CONCLUSION
CHAPTER 71:
Genital Tuberculosis in Recurrent Implantation Failure
INTRODUCTION
CLINICAL DISCUSSION
Female Genital Tuberculosis: Epidemiology
Pathogenesis
Genital Tuberculosis and Infertility
Effect of Genital TB on Ovarian Function
Effect of Genital Tuberculosis on Endometrial Function
Clinical Presentation of Female Genital TB
Clinical Signs
Diagnosis
Treatment
Medical Treatment
Monitoring
Surgical Treatment
In Vitro Fertilization and Embryo Transfer (IVF-ET) in Genital TB
Gestational Surrogacy in Genital TB
NEW TUBERCULOSIS RESEARCH
CONCLUSION
CHAPTER 72:
Recurrent Implantation Failure: The Preferred Therapeutic Approach
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Improving Endometrial Performance
Myomectomy
Thin Endometrium
Immunotherapy
Thrombophilia
Gamete and Embryo Factors
Treatment Options for Embryo Enhancement
Methods of Embryo Assessment
Multifaceted Treatment Options
Treating Endometriosis
Salpingectomy for Hydrosalpinges
Psychological Support
CONCLUSION
CHAPTER 73:
The Dilemma in Investigating Repeated Pregnancy Loss
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
How to Deal with a Case of Repeated Pregnancy Loss?
Genetic Defects Causing Repeated Pregnancy Loss
Embryonic Chromosomal Abnormalities
Carrier State of the Parents
When and How to Investigate for Genetic Defects?
Preimplantation Genetic Screening (PGS)
Maternal Causes
Maternal Age and Lifestyle
Obesity and Other Metabolic Causes
Defects in the Uterus and Cervix
Defects in the Hormonal Milieu/Endocrine Causes
Infections of the Reproductive Organs/Tract
Thrombophilia
Immunological Causes
The Endometrium in Repeated Pregnancy Failure
Role of Natural Killer Cells
Role of Cytokines
Mannose-binding Lectin
CONCLUSION
KEY POINTS
CHAPTER 74:
Antiphospholipid Antibodies in ART
INTRODUCTION
Manifestations
Incidence
Diagnosis
CLINICAL DISCUSSION
Pathophysiology
Antiphospholipid Antibodies and Recurrent Abortions
Antiphospholipid Antibodies and Assisted Reproduction
Treatment
Rationale for Heparin-Aspirin Therapy
Treatment Recommendations
RECENT ADVANCES
CONCLUSION
CHAPTER 75:
Future Directions in Failed Implantation in ART
SUMMARY
RATIONALE
INTRODUCTION
Reduced or Defective Embryonic Development
Decreased Endometrial Receptivity
Multifactorial Causes
CLINICAL DISCUSSION
Embryo Selection
Treatment Options for RIF
Hysteroscopic Correction of Cavity Pathology
Uterine Factors
Treatment of Thin Endometrium
Endometrial Stimulation
Immunotherapy
Assisted Hatching
Zygote Intrafallopian Transfer
Co-culture
Blastocyst Transfer
Cytoplasmic Transfer
Improving the ET Technique
Sperm Factors
Treatment Options for Multifactorial Causes of RIF
Treating Endometriosis
Direct Flushing of the Endometrial Cavity
Danazol
Salpingectomy of Hydrosalpinges
Tailoring the Stimulation Protocol
Psychological Assistance
CASE STUDIES
RECENT ADVANCES
CONCLUSION
SECTION 8: CRYOPRESERVATION
CHAPTER 76:
Cryopreservation of Oocytes and Embryos
INTRODUCTION
History
CLINICAL DISCUSSION
Indications for Embryo and Oocyte Cryopreservation (Table 76.1)
Biological and Technical Aspects
Embryo Survival
Clinical Outcome
Our Experience
Religious and Ethical Issues
Buddhist View 28
Islamic View
Jewish View
Roman Catholic View
CHAPTER 77:
Human Oocyte and Embryo Cryopreservation
INTRODUCTION
Cryostorage of the Female Gamete
CLINICAL DISCUSSION
Cryopreservation of the Preimplantation Human Embryo
Selection Criteria for HumanBlastocysts for Cryopreservation
Why Freeze Embryos at the Blastocyst Stage?
Routine Freezing of Blastocysts
RECENT ADVANCES AND CONCLUSION
The Future of Oocyte and Embryo Cryopreservation
APPENDIX 1
Human Egg Cryopreservation (Conventional)
Freeze
Thaw
APPENDIX 2
Human Egg Cryopreservation (Vitrification)
Vitrification
Warming
APPENDIX 3
Blastocyst Cryopreservation: Vitrification Shady Grove RSC Protocol
Vitrification
Warming
APPENDIX 4
Blastocyst Cryopreservation: Slow-FreezeShady Grove RSC Protocol
Freezing
Thawing
CHAPTER 78:
Oocyte Vitrification: Principles, Applications and Achievements
INTRODUCTION
History
Indications for Oocyte Freezing
Fertility Preservation
Overcoming Legal and Ethical Issues Related to Embryo Freezing
Donor Oocyte Banks
Challenges Associated with Oocyte Cryopreservation
Size
Spherical Shape
Low Cell Number
Chromosomal Arrangement
Osmotic Shock
Cryoinjuries
CLINICAL DISCUSSION
Best Approach to Oocyte Cryopreservation
Vitrification
Procedure for Oocyte Freezing
Oocyte Retrieval
Timing
Oocyte Freezing
Optimal Timing for Vitrification of Oocytes and Fertilization (Fig. 78.2)
Cost
Clinical Applications of Oocyte Vitrification
Donor Oocyte Cryopreservation
Non-donor or Autologous Oocyte Cryopreservation
Novel Indications
Factors Influencing Outcomes of Oocyte Cryopreservation
Safety and Risk Assessment
Ethical Issues Associated with Oocyte Cryopreservation
Duration of Storage
The Rotunda Experience
CONCLUSION
CHAPTER 79:
Slow-rate Freezing versus Vitrification for Oocytes and Embryos: An Evaluation of the Methodology and Outcomes
INTRODUCTION
CLINICAL DISCUSSION
Slow Freezing
History of Slow Freezing
Sucrose Concentration
Temperature of Equilibration
Increasing the Pre-equilibration Time
Alteration of Electrolyte Composition
Methodology (Tables 79.1 to 79.5)
Protocol
Slow Freezing Procedure in Detail
Vitrification
History of Vitrification
Biophysics behind Vitrification
Vitrification Devices
Time of Vitrification
Technical Demands
Why Freeze Oocytes?
Why Freeze Embryos?
Outcomes
Studies Comparing Slow Freezing and Vitrification
CONCLUSION
CHAPTER 80:
Cryopreservation of Human Spermatozoa
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Indications for Human Sperm Cryopreservation
Sperm Preparation Techniques that Influence Cryopreservation
Effects of Freezing on Sperm Quality
Fertilization Rates with Cryopreserved Spermatozoa
Cryobanking of Semen for Fertility Protection from Cytotoxic Treatment
Use of Cryopreserved Epididymal and Testicular Spermatozoa for ICSI
CONCLUSION
CHAPTER 81:
Cryoprotectant-free Sperm Vitrification for IVF/ICSI: A Novel Technology
INTRODUCTION
Conventional Freezing and Thawing of Spermatozoa
Mechanical Injury
Chemical and Physical Damage
Antioxidant Defence
Effect of Cryoprotectant
DNA Damage
CLINICAL DISCUSSION
Vitrification of Spermatozoa
Cryoprotectant-free Vitrification is Best Suited for Human Spermatozoa
Vitrification Methods
Factors Affecting Successful Vitrification
Cooling Rate
Warming Rate and Devitrification
Methodologies of Cooling and Warming
Sample Size
Success Rates
Comparison of Slow Freezing and Vitrification
Comparison of Vitrification in the Presence or Absence of Low CPA Concentrations
CONCLUSION
CHAPTER 82:
Can We Make IVF Safer with Vitrification?
SUMMARY
INTRODUCTION
Cryopreservation Techniques
Vitrification
CLINICAL DISCUSSION
Vitrification: a Stepping Stone towards Safer IVF
Avoiding Multiple Pregnancies by Restricting the Number of Embryos Transferred
Implications
Prevention of OHSS by Elective Cryopreservation of All Embryos
Implications
Cryopreservation of All Embryos for Remote Cycle Transfer with Better Endometrial Receptivity
Implications
CONCLUSION
CHAPTER 83:
Ovarian Cortex Vitrification
SUMMARY
INTRODUCTION
The Human Ovary: Anatomical Aspects
Fertility Preservation
Premature Ovarian Failure
Toxic Impact of Chemotherapy and Radiotherapy
CLINICAL DISCUSSION
Cryobiology and Fertility Preservation
Preservation of Cells and Complex Tissues
Cryopreservation of Ovarian Cortical Tissue
Vitrification of Human Ovarian Tissue
Assessment of the Morphology and Functionality of the Tissue
Transplantation of Ovarian Tissue (Table 83.6)
CONCLUSION
CHAPTER 84:
Semen Cryopreservation and Sperm DNA Damage
SUMMARY
INTRODUCTION
Indications for Semen Cryopreservation
Sperm Cryodamage
Role of Sperm DNA in Reproduction
CLINICAL DISCUSSION
Clinical Significance of Sperm DNA Damage
Evaluation of Sperm DNA Damage
Mechanism of Sperm DNA Damage during Cryopreservation
Future of Sperm DNA Analysis Tests
Methods to Reduce Sperm Cryopreservation Induced DNA Damage
Cryopreservation Media
Sperm Sample Processing
CONCLUSION
SECTION 9: ENDOSCOPY AND ART
CHAPTER 85:
Fertility Following Laparoscopic Surgery and Hysteroscopic Surgery
INTRODUCTION
CLINICAL DISCUSSION
Advantages of Endoscopic Surgeryin an Infertile Patient
Laparoscopic Surgical Treatment of Infertility Related to PCOD
Our Experience
Complications of Drilling
Laser Drilling
Conclusion
Laparoscopic Surgery for Endometriosis in an Infertile Patient
Laparoscopy versus Laparotomy
Conservative Laparoscopic Surgery
Lysis of Bowel Adhesions
Peritoneal Implants
Ovarian Endometriosis
Restoration of Tubo-ovarian Anatomy (Fig. 85.3)
Fertility Following Laparoscopic Surgery for Endometriosis
Laparoscopic Reconstructive Tubal Surgery
Laparoscopic Survey
Salpingo-ovariolysis
Results of Salpingo-ovariolysis
Fimbrioplasty
Results of Fimbrioplasty
Laparoscopic Salpingostomy
Laparoscopic Myomectomy
Hysteroscopic Surgeries in Infertile Patients
Instrumentation
Diagnostic Hysteroscopy
Operative Hysteroscopy
CHAPTER 86:
The Role of Hysteroscopy in the Management of Infertility
INTRODUCTION
CLINICAL DISCUSSION
Hysterosalpingography
Pelvic Ultrasound
Sonohysterography
Hysteroscopy and Assisted Reproductive Techniques
CONCLUSION
CHAPTER 87:
Modern Management of the Ischemic Black-blue Twisted Adnexa
INTRODUCTION
CLINICAL DISCUSSION
Extirpative Therapy
Conservative Management
Can the Ischemic Tissue Recover?
Does Detorsion Increase the Risk of Thromboembolism?
Can Detorsion Postpone the Treatment of a Hidden Malignancy?
The Risk of Retorsion
CONCLUSION
CHAPTER 88:
Fertiloscopy: A New Technique and an Alternative to Conventional Laparoscopy in Infertility
INTRODUCTION
CLINICAL DISCUSSION
Indications
Technique
Preoperative Work-up and Patient Selection
Instrumentation (Fig. 88.1)
Fertiloscopy Introducers
Operative Instruments
Room Set-up (Fig. 88.1)
Procedure
Pelvic Examination
Anesthesia
Introduction of the Uterine Fertiloscope (Figs 88.3 A to C)
Creating a Hydroperitoneum
Introduction of the Douglas Fertiloscope (Figs 88.4 A to C)
Operative Channel
Exploration of the Pelvis (Figs 88.5 to 88.7)
Contraindications to Fertiloscopy
Complications
No Visualization
Partial Visualization
Bleeding
Retroverted Uterus
False Route
Pelvic Pathology
FUTURE DIRECTIONS
CONCLUSION
CHAPTER 89:
Uterine Cavity Evaluation by Hysteroscopy, Saline Infusion Sonohysterography and Transvaginal Sonography Prior to IVF-ICSI
INTRODUCTION
CLINICAL DISCUSSION
How to Assess the Endometrial Cavity?
Vaginal Ultrasound
Sonohysterography (Saline Infusion Ultrasound)
Hysterosalpingography
Hysteroscopy
Transvaginal Ultrasound Scan
Saline Hysterosonography
Other Imaging Modalities
Three-dimensional (3D) Ultrasound
Magnetic Resonance Imaging
Hysteroscopy
Recommendations on Hysteroscopy
CONCLUSION
CHAPTER 90:
Hysteroscopic Assessment of Selective Tubal Pressures and Tubal Cannulation by Air Bubble Stents
INTRODUCTION
CLINICAL DISCUSSION
Hysteroscopic Markers for an Optimal Septoplasty
Hysteroscopic Fibroid Resection: An Endometrial and Myometrial Conserving Approach
Hysteroscopic Markers for Endometritis
Hysteroscopic Assessment of Selective Tubal Pressure
Procedure
CONCLUSION
CHAPTER 91:
Intrauterine Adhesions
INTRODUCTION
CLINICAL DISCUSSION
Etiology and Pathogenesis
Diagnosis
Classification
Technique of Hysteroscopic Adhesiolysis
Postoperative
Success Rate
CONCLUSION
SECTION 10: ULTRASONOGRAPHY
CHAPTER 92:
Update on Ultrasound-guided Embryo Transfer
INTRODUCTION
What Factors are Important for Successful ET?
Absence of Bleeding/Blood on the Catheter
Type of Catheter Used
Not Touching the Fundus
Avoiding the Use of a Tenaculum
Removal of Mucus from the Cervix
Leaving the Catheter in Place for at least One Minute
Thirty Minutes Rest after Transfer
Trial Transfer before Treatment
CLINICAL DISCUSSION
Ultrasound Monitoring of Embryo Transfer
Does Ultrasound-guidance Increase Pregnancy Rates?
Is Ultrasound-guidance Always Necessary?
Does Ultrasound-guidance Reduce the Incidence of Ectopic Pregnancy?
Proper Placement and Position of Catheter
What is the Role of Three-dimensional (3D) and Four-dimensional (4D) Ultrasound?
Transvaginal Ultrasound-guided ET
CONCLUSION
CHAPTER 93:
Cervical Mucus Evaluation by Transvaginal Ultrasonography: A Novel Approach
INTRODUCTION
MATERIALS AND METHODS
Phase I
Phase II
RESULTS
CLINICAL DISCUSSION
CONCLUSION
SECTION 11: THE MALE FACTOR
CHAPTER 94:
Non-obstructive Azoospermia: Predictive Criteria for Sperm Retrieval
INTRODUCTION
CLINICAL DISCUSSION
Parameters Considered
Testicular Volume
Serum Follicle-stimulating Hormone
Inhibin B
Study of the Ejaculate
Genetic Considerations
Predictability for Repeat Procedure
Minimizing False Negative Sperm Retrieval
CONCLUSION
CHAPTER 95:
Epididymal and Testicular Sperm Retrieval
INTRODUCTION
CLINICAL DISCUSSION
Indications
Sperm Retrieval Methods
Epididymal Sperm Retrieval
Testicular Sperm Retrieval
Open Epididymal Sperm Retrieval
Microsurgical Epididymal Sperm Aspiration
Open Fine Needle Aspiration
MESA versus OFNA
Percutaneous Epididymal Sperm Retrieval
Percutaneous Epididymal Sperm Aspiration
Open versus Closed Epididymal Sperm Retrieval
Percutaneous Testicular Sperm Retrieval
Testicular Sperm Aspiration
Needle Aspiration Biopsy
TESA versus NAB
Needle Biopsy
Open Testicular Sperm Retrieval
Conventional Biopsy
Single Seminiferous Tubule Biopsy
Microsurgical Selective Biopsy
Percutaneous versus Open Biopsy
Open Conventional Biopsy versus Microsurgical Biopsy Techniques
Choice of Procedure
CONCLUSION
CHAPTER 96:
Microdeletions in the Y-Chromosome and Male Infertility
SUMMARY
INTRODUCTION
Overview of Male Infertility
Genetic Basis of Male Infertility
CLINICAL DISCUSSION
History/Epidemiology of Y-chromosome Microdeletions
Structure of the Y-chromosome (Fig. 96.1)
Methodology and Testing
Transference Mechanism and Mutation Etiology
Treatment Options and Counseling
CONCLUSION
CHAPTER 97:
Isolated Teratozoospermia
SUMMARY
INTRODUCTION
Semen Analysis: A Surrogate Measure of Male Fertility
CLINICAL DISCUSSION
WHO Assessment Guidelines for Sperm Morphology
Isolated Teratozoospermia and ART
Current Reproductive Outcomes in Teratozoospermia
Factors Affecting Sperm Morphology
Stress
Pollution
Leukocytospermia (Infection)
Smoking
Semen Variables According to Cigarettes Per Day
Alcohol
Sperm Function in Isolated Teratozoospermia
CONCLUSION
CHAPTER 98:
Hormone Substitution in Male Infertility
INTRODUCTION
CLINICAL DISCUSSION
Human Chorionic Gonadotropin
Human Menopausal Gonadotropin
Pure and Recombinant FSH
Gonadotropin-releasing Hormone
Androgens
Testosterone Undecanoate
Mesterolone
SECTION 12: PREIMPLANTATION GENETIC DIAGNOSIS
CHAPTER 99:
Preimplantation Genetic Diagnosis for ART: Why, When and How?
SUMMARY
INTRODUCTION
The History of PGD and PGS Testing of Embryos for In Vitro Fertilization
CLINICAL DISCUSSION
Indications for PGD
Indications for PGS
Embryo Biopsy
Methods of PGD
Polymerase Chain Reaction (PCR)
Fluorescent in situ Hybridization (FISH)
Comparative Genomic Hybridization (CGH) and Array Comparative Genomic Hybridization (aCGH)
Single Nucleotide Polymorphism (SNP) Array
Quantitative Real-time Polymerase Chain Reaction (qPCR)
Digital PCR
Next Generation Sequencing
Clinical Advantages
CONCLUSION
CHAPTER 100:
Preimplantation Genetic Screening in Assisted Reproduction Techniques
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Preimplantation Genetic Screening Techniques
What Technique Should be Chosen?
PGS Indications
Mosaicism
Chromosomes Affected in PGS
Preimplantation Genetic Screening:Technique Description
Embryo Biopsy
Biopsied Cell Processing
CONCLUSION
CHAPTER 101:
Preimplantation Genetic Diagnosis in Infertile Patients of Advanced Maternal Age
SUMMARY
INTRODUCTION
Meiotic Abnormalities
CLINICAL DISCUSSION
Studies in Oocytes
Clinical Application of Preimplantation Genetic Diagnosis for Advanced Maternal Age
CONCLUSION
CHAPTER 102:
Study of the Infertile Men I: Genetic and Non-genetic Causes
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Pretesticular Causes
Genetic Hypothalamic and Pituitary Causes
Acquired Hypothalamic and Pituitary Causes
Testicular Causes of Infertility
Anorchia
Cryptorchidism
Varicocele
Testicular Tumors
Orchitis, Traumas and Testicular Torsion
Genetic Disorders
Gonadotoxic Effect
Systemic Diseases
Renal Failure
Liver Failure
Sickle Cell Disease
Idiopathic Infertility
Disorders of Sperm Transport
Disorders of Sperm Motility or Function
Sexual Dysfunction
CONCLUSION
CHAPTER 103:
Study of the Infertile Men II: Genetic Studies in Somatic Cells
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Chromosomal Abnormalities: Karyotype Analysis
Sex Chromosomal Abnormalities
Klinefelter Syndrome and its Variants (47, XXY; 46,XY/47, XXY Mosaicism)
47, XYY Syndrome
46,XX Male Syndrome
45,X/46,XY Mosaicism (Mixed Gonadal Dysgenesis)
Structural Abnormalities of the X-chromosome
Structural Abnormalities of the Y-chromosome
Autosomal Abnormalities
Translocations
Inversions
Interchromosomal Effects
Indications for Karyotype Analysis
Y-chromosome Microdeletions
Types of Microdeletions
Indications for Screening the Y-chromosome and Clinical Relevance
Screening for Cystic Fibrosis Transmembrane Conductance Regulator Gene
Indications for Screening Cystic Fibrosis and Clinical Relevance
Genetic Counseling
CHAPTER 104:
Study of the Infertile Men III: Genetic Studies in Germ Cells
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Study of Sperm by FISH
Indications
Methodology
Clinical Applications of Sperm FISH Study
Study of Meiosis in the Testicular Tissue
Indications
Methodology
Clinical Application of the Study of Meiosis
Sperm DNA Fragmentation
Sperm DNA Fragmentation Assessment
Effect of Sperm DNA Damage on Reproductive Outcomes
Causes of Sperm DNA Fragmentation
Indications for SDF Assessment
Methodology
Clinical Application Study of Sperm DNA Fragmentation
Treatment
CONCLUSION
CHAPTER 105:
Preimplantation Genetic Diagnosis for Single Gene Disorders
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Technical Overview
CLINICAL DISCUSSION
Case Scenarios
Adult-onset Conditions and Exclusion Testing
PGD for Single Gene Disorders Caused by de novo Mutations
PGD for Mitochondrial DNA Diseases
PGD for Two or More Conditions
PGD for Single Gene Disorders Plus Human Leukocyte Antigen Matching
Combined PGD for Single Gene Disorders and Chromosome Screening
RECENT ADVANCES
Karyomapping
Next-generation Sequencing
CONCLUSION
CHAPTER 106:
Aneuploidy and Time-lapse
SUMMARY
INTRODUCTION
Classical Embryo Grading
Embryo Morphology and Aneuploidy
CLINICAL DISCUSSION
Morphokinetic Embryo Assessment
Morphokinetics and Aneuploidy
Applicability: Can Morphokinetics Replace PGS?
CONCLUSION
CHAPTER 107:
The Scope of Preimplantation Genetic Diagnosis
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Preimplantation Genetic Diagnosis for Single Gene Disorders with Mendelian Inheritance
Polar Body Diagnosis and Preimplantation Genetic Diagnosis
Techniques Used in the Diagnosis of Single Cells for Patients with Mendelian-inherited Genetic Diseases
Techniques Used in the Polar Body: Preimplantation Genetic Diagnosis Protocol
Advantages and Disadvantages of Polar Body Diagnosis
Indications for Preimplantation Genetic Diagnosis
Cardiac Predisposition
Cancer Predisposition
Single Gene Disorders with Human Leukocyte Antigen Matching
Preimplantation Genetic Screening
Fluorescence In Situ Hybridization
Comparative Genomic Hybridization
Risks and Ethical Considerations
CONCLUSION
SECTION 13: IN CONCLUSION
CHAPTER 108:
The Significance of Validating New IVF Technology: Think Before You Act
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Validation
Systematic Reviews
How do we find out about New Technology?
Role of Professional Groups
Health and Safety and Risks
‘New’ Technologies: Past and Present
New Technology 1
New Technology 2
New Technology 3
New Technology 4
New Technology 5
CONCLUSION
CHAPTER 109:
Patient Support in the ART Program
INTRODUCTION
Stress and Infertility
CLINICAL DISCUSSION
Objectives of Counseling
Indications for Counseling
Fundamental Areas of Concern/Situations Demanding Counseling
Continued Treatment with Persistent Failure
Third Party Reproduction
Complications Associated with Pregnancy after Infertility
Threatened Sexuality
Gender Differences
Chronic History of Illness or Psychiatric Disease
Genetic Counseling
Cryopreservation
Types of Counseling
Therapeutic Counseling
Implications Counseling
Support Counseling
Counseling Approach
Single Counseling
Couple Counseling
Group Counseling
Counseling Team Responsibilities
Media for Patient Support
Patient Support Booklets
Telephone Counseling
Self-Help Groups
Patient Support Organizations
CONCLUSION
CHAPTER 110:
Politics, Partnerships and IVF
SUMMARY
INTRODUCTION
Limited Recognition of Infertility as a Disease or Medical Condition
Early History
The 1996 Campaign
CLINICAL DISCUSSION
Equity of Access to ART
The Impact of legislation on ART Treatment
Reproductive Technology Accreditation Committee
Real Costs of Infertility: Societal, Social, Emotional
CONCLUSION
CHAPTER 111:
In Vitro Fertilization Success from a Clinician's Viewpoint: How to Get it, How to Keep it
INTRODUCTION
CLINICAL DISCUSSION
Patient Selection
Stimulation Protocol
Normal Responders
Poor Responders
High Responders
Oocyte Retrieval
Embryo Transfer
Introduction
Trial Embryo Transfer
Embryo Transfer
Other Issues Regarding ET
Ultrasound-guided ET
Extended Embryo Culture (Blastocyst)
CONCLUSION
CHAPTER 112:
Bandwagons in IVF Revisited: Does One Size Really Fit All?
INTRODUCTION
CLINICAL DISCUSSION
Bandwagons in IVF: What are They?
Assisted Hatching
General Considerations
Partial Zona Dissection
Zona Drilling using Acid Tyrode's Solution
Zona Thinning/Removal using Acid Tyrode's Medium
Zona Drilling using Laser-assisted Methods
Assisted Hatching: Who Benefits
Summary and Conclusions
Intracytoplasmic Sperm Injection
General Considerations
ICSI: Who and When? ICSI versus IVF
Risks from the Technique
Risks of Chromosomal Abnormalities
Summary and Conclusion
Extended Embryo Culture/Blastocyst Transfer
General Considerations
Extended Culture/Blastocyst Transfer: Risks and Limitations
Summary and Conclusions
CONCLUSION
CHAPTER 113:
Intracytoplasmic Sperm Injection for All?
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Male Factor Infertility
Non-male Factor Infertility
Unexplained Infertility
Poor Quality Oocytes
Advanced Maternal Age
Prior Failed Fertilization with Conventional Insemination
Intracytoplasmic Sperm Injection for Routine Use
Preimplantation Genetic Testing
Intracytoplasmic Sperm Injection after In Vitro Maturation
Oocyte Cryopreservation
CONCLUSION
CHAPTER 114:
Legal and Ethical Considerations in Assisted Reproductive Techniques
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Bypassing the Natural Method of Conception: The Religious Stand
Gender Issues
Inequality in the Access to ART
Embryo Research
Embryo Cryopreservation
Multiple Gestation and its Implications: Embryo Reduction
Gamete Donation
Surrogacy: Gestational Carriers
Posthumous Reproduction
Preimplantation Genetic Diagnosis
CONCLUSION
INDEX
TOC
Index
×
Chapter Notes
Save
Clear