SECOND EDITION
Editors
Gautam Nand
Allahbadia
MD DNB FNAMS DGO DFP FICOG FCPS FICMU
Medical Director and Consultant IVF Aster IVF Clinic Aster Hospital, Mankhool, Bur Dubai
Dubai, UAE
Group Clinical Director Rotunda–The Center for Human Reproduction
Mumbai, Maharashtra India
Monikaa Malhotra
Chawla
MD FRCOG (UK)
Reproductive Endocrinologist and Fertility Specialist Obstetrician and Gynecologist Fakih IVF
Abu Dhabi and Dubai UAE
Rita
Basuray Das
PhD
Visiting Instructor College of Arts and Sciences University of Kentucky
Lexington, Kentucky USA
Goral
Neeraj Gandhi
MSc
Laboratory Director Vice President (Operations) Rotunda–The Center for Human Reproduction
Mumbai, Maharashtra India
Esther
Velilla Garcia
PhD
Director Reproductive Biology Service Senior Embryologist and PGD Specialist The PGD Laboratory
Barcelona Spain
Rubina
Merchant
PhD
Embryologist Rotunda–The Center for Human Reproduction Mumbai,
Maharashtra India
Foreword
Mohamed
Aboulghar
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fm19Foreword
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© 2017, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
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The Art and Science of Assisted Reproductive Techniques (ART)
First Edition: 2003
Second Edition:
2017
9789386322821
fm5Dedication
This book is dedicated to the Scientists who are changing
the world of Reproductive Medicine with their cutting-edge research
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fm7Contributors
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The last three decades have witnessed several major advances in Reproductive Medicine. Since the first human baby by in vitro fertilization (IVF), the assisted reproductive techniques (ART) have become a routine and widely accepted treatment for infertility. It has been estimated that in some European countries, up to 5% of all births are due to ART. It is clear that ART has made a significant impact on the lives of many infertile and subfertile couples. Although infertility may not be a public health priority in many countries, yet, it is a central issue in the lives of individuals who suffer from it.
The idea behind this work was to produce a comprehensive book, which could cover, in detail, all the aspects of Assisted Reproduction.
The rapid pace of development tends to limit the opportunity to ponder upon many of the technical, social and moral implications of new technologies, both in terms of advantages for patients and physicians, and of the potential damages and complications. The popularity of the subject and the very fast advance in the field of ART inevitably attracted a large number of authors to contribute to different angles of the topic. It is clear that the strategy of the editors was to encourage an unbiased approach to the most relevant aspects of this field by as many top-level scientists from around the globe as possible. It is believed that the massive explosion in the amount and complexity of the clinically relevant scientific information has not yielded to increased bewilderment and uncertainty. On the contrary, we have witnessed and exploited large emerging and unifying themes that have brought greater clarity and comprehension to otherwise contradictory and counterintuitive and, often, unexplained findings. In addition, with more information, we now have greater insight into the variability and uniqueness of clinical presentation that the patients display.
The previous edition of The Art and Science of Assisted Reproductive Techniques was a great success in India and different parts of the world.
One of the excellent aspects of the book is that many authors have written their contributions with an evidence-based approach.
It is clear that the great success of the first edition was a strong incentive for the editors to work on the new edition, where gaps could be filled and new ideas and information added.
The introductory section of the book includes two parts. The first part, written by Zeev Blumenfeld, which covers the endocrinology of ART offers a good basic coverage of the topic, and will help the reader to follow the majority of topics related to endocrinology, which is an integral part of ART. The second part of the introduction, written by Krishnendu Gupta, Sajal Datta, and Bijit Chowdhury, discusses the modern work-up of infertility, which has undergone important modifications in the past few years.
deals with ovarian stimulation strategies, which include sub-divisions of each oral drug used for ovarian stimulation, tamoxifen, and aromatase inhibitors. Different types of gonadotropins are discussed. Three chapters are devoted to poor responders from different angles. The use of GnRH analogs and all other adjuncts to ovarian stimulation are included. The management of difficult and complex cases is discussed. Individualization of ovarian stimulation protocols and the ovarian hyperstimulation syndrome and its prevention are emphasized upon. Surgical procedures to promote ovulation are discussed separately.
is devoted solely to polycystic ovary syndrome and its genetics and consequences.
is devoted to details of different ART procedures, starting with oocyte collection upto embryo transfer including single embryo transfer and blastocyst transfer.
is devoted to laboratory issues, starting with all the aspects related to the semen analysis, embryo screening, non-invasive and invasive procedures. The quality of the laboratory and its significance is well documented. The laboratory procedures are critically analyzed.
There is an interesting on ‘Contemporary Thoughts’ that explores the improvement in IVF outcome, endometrium and infertility, ART in elderly women, HIV and ART, outcome of IVF/intracytoplasmic sperm injection (ICSI) babies as well as ovarian torsion prevention.
is devoted to the use of laparoscopy, hysteroscopy, fertiloscopy and hysterosalpingography in the management of infertility. A short on ultrasound and ART is also included. discusses all the aspects of male infertility, which cover the hormone substitution theory, methods of sperm retrieval in azoospermia, and Y-chromosome microdeletions and infertility. Preimplantation genetic diagnosis and screening are discussed in depth in .
The last includes the significance of validating IVF technology, how to support the couple psychologically and, additionally, the legal and ethical issues that revolve around ART.
In conclusion, this is a comprehensive book, that addresses the most pressing problems of ART and infertility. It updates the reader with all sorts of technology used in this field, and attempts to offer pragmatic and cost-effective solutions, which can be employed directly into clinical practice, while minimizing complications. It offers an insight into the varieties of hormone stimulation protocols used for ART procedures. All possible complications and their prevention are also discussed in detail. The value of mild stimulation protocols, specifically in conjunction with the latest cryopreservation techniques, is explored.
This book is based on great efforts by the talented editors and contributors from all around the globe. It covers the most up-to-date topics, along with some procedures, which are not currently used. The book is very useful for clinicians, residents and embryologists, and the reader will find comprehensive information on almost all topics related to ART.
Mohamed Aboulghar MD
Professor
Department of Obstetrics and Gynecology
Faculty of Medicine, Cairo University
Clinical Director
The Egyptian IVF Center
Cairo
Egypt
fm21Preface
There is, perhaps, no field of science that has so intrigued and relentlessly engaged the human mind as that of Assisted Reproduction, roping in the efforts of a gamut of professionals from clinicians, researchers, embryologists, geneticists, molecular biologists, surgeons, psychologists and law-makers to fulfil the patients’ yearning desire for a live healthy baby. New innovations in thought, research and technology have delivered promising approaches to the management of infertility; nevertheless, this seeming conquest of infertility has opened a Pandora's box of new challenges for the clinicians and patients to grapple with, which demand safe and cost-effective solutions, dictated by evidence-based research and the experience of experts and pioneers in the field.
The Art and Science of Assisted Reproductive Techniques, in its second revised edition, an excellent compilation of the views and practice of luminaries from the various areas of Assisted Reproduction, with its 13 sections, each dedicated to a specific sub-specialty, aims to do just that! It meticulously takes the reader on an intellectual journey through the various ovarian stimulation drugs and strategies, with valuable updates on polycystic ovary syndrome (PCOS), and the assisted reproductive technique (ART) procedures, their indications, limitations, and clinical outcomes. Laboratory issues that are crucial to the success of an ART program are elaborated, emphasizing the fundamentals, and highlighting the advanced techniques and the significance of quality management, quality assurance and risk management in establishing and maintaining a purposeful ART laboratory. Some of the most perplexing questions, such as ART in disease conditions—endometriosis, HIV and genital tuberculosis, the genetics of infertility, management of advanced maternal age women, how to improve success rates following ART, and the clinical, ethical, legal, psychological and emotional aspects of gamete and embryo donation, surrogacy and adoption that have often confounded clinical practice, are answered in sections on Contemporary Thoughts and Third Party Reproduction, respectively. The value of cryopreserving gametes, embryos and tissues, using new technologies such as vitrification, is surfaced, and the various causes of male infertility and the respective measures to alleviate it, are elaborated. Modulators of endometrial receptivity, key regulators in the embryo-endometrium molecular cross-talk and consequently, implantation, are highlighted, providing insights into the pathophysiology of implantation failure and recurrent pregnancy loss, while giving future directions in failed implantation following ART. Sections on Endoscopy and Ultrasonography offer a telescopic view into the pelvic cavity with the aim to solve surgical dilemmas, facilitate the management of anatomical causes of infertility and, additionally, guide embryo transfer.
Advances in molecular genetic techniques, such as array-comparative genome hybridization (a-CGH), comprehensive chromosome screening (CCS), single-nucleotide polymorphism (SNP) microarray, quantitative polymerase chain reaction (qPCR) for preimplantation genetic diagnosis (PGD), devised to screen the embryonic genome for genetic and chromosomal disorders to prevent the transfer of inheritable disorders in offspring, and advances in embryo screening, such as time-lapse imaging, are provided to keep the reader abreast with the latest cutting-edge technology. Their roles in Assisted Reproduction, applications, advantages, outcomes, limitations, drawbacks and future possibilities, are critically analyzed to equip the reader with the necessary knowledge to effectively use these techniques. The book, however, concludes with the significant message of thinking before jumping onto the bandwagon and ensuring that every new technology is validated before being implemented in the ART laboratory and into clinical practice to offer the patients a justifiable solution to their problems. The value of individualized treatment protocols, patient counseling and support in an ART program are emphasized, as are the ethical and legal considerations in ART.
We hope that we have been successful in our motive of enriching the reader with the updated theoretical and practical knowledge that is indispensable to the understanding and practice of Assisted Reproduction. We are deeply indebted to our contributors for their invaluable contributions in helping us to realize this comprehensive and stimulating volume.
Gautam Nand Allahbadia
Monikaa Malhotra Chawla
Rita Basuray Das
Goral Neeraj Gandhi
Esther Velilla Garcia
Rubina Merchant