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
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fm1THE ART AND SCIENCE OF ASSISTED REPRODUCTIVE TECHNIQUES (ART)
fm2 fm3THE ART AND SCIENCE OF ASSISTED REPRODUCTIVE TECHNIQUES (ART)
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
fm4
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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
fm6 fm7Contributors
  • Aditi Mulgund MD MPH
  • Resident Physician
  • Internal Medicine
  • University of Cincinnati Medical Center
  • Cincinnati, Ohio
  • USA
  • Alka Kumar MD
  • Director
  • Women's Medical Center
  • Consultant Hysteroscopic Surgeon
  • Anil Nursing Home
  • Jaipur, Rajasthan
  • India
  • Akanksha G Allahbadia MBBS
  • Resident
  • Department of Obstetrics and Gynecology
  • Dr DY Patil Medical College and Hospital
  • Pune, Maharashtra
  • India
  • Alka Prakash MRCOG MD
  • Consultant Obstetrician and Gynecologist
  • Department of Reproductive Medicine and Surgery
  • Addenbrooke's Hospital
  • Clinical Lead, Cambridge IVF
  • Cambridge University Hospitals NHS Trust
  • Cambridge
  • UK
  • Akanksha Mishra MSc (Clinical Embryology)
  • Consultant Embryologist
  • Aveya Fertility Center
  • Fortis Healthcare
  • New Delhi
  • India
  • Altaf A Kondkar PhD
  • Glaucoma Research Chair
  • Department of Ophthalmology
  • Molecular Genetics Laboratory
  • College of Medicine
  • King Saud University
  • Riyadh
  • Kingdom of Saudi Arabia
  • Alan Bolnick MD
  • Obstetrician and Gynecologist
  • Division of Reproductive Endocrinology and Infertility
  • Department of Obstetrics and Gynecology
  • Wayne State University Medical School
  • Detroit, Michigan
  • USA
  • Amal Al-Shunnar MD MRCOG
  • Consultant Obstetrician and Gynecologist
  • Co-founder
  • Fakih IVF
  • Dubai
  • UAE
  • Alex C Varghese PhD
  • Scientific and Laboratory Director
  • Astra Fertility Group
  • Mississauga
  • Canada
  • Andrea Borini MD
  • Director
  • Tecnobios Procreazione
  • Center for Reproductive Health
  • Bologna
  • Italy
  • Ali M Hellani PhD MGSA
  • Laboratory Director and Founder
  • Viafet Genomics Center
  • PGD Laboratory
  • Dubai
  • UAE
  • Angela Beaten PhD
  • Chief Scientist
  • Isis Clinic
  • Waikato, Hamilton
  • New Zealand
  • Alka Kriplani MD FRCOG FAMS FICOG FIMSA FICMCH
  • Professor
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi
  • India
  • Angeline N Beltsos MD
  • CEO and Medical Director
  • Reproductive Endocrinologist and Infertility Specialist
  • Clinical Research Division Director
  • Vios Fertility Institute
  • Chicago, Illinois
  • USA
  • Anil B Pinto MD FRCOG FACOG
  • Private Practice
  • Affiliated with Baylor University Medical Center
  • Dallas, Texas
  • USA
  • Attila Vereczkey MD MA
  • Medical Director
  • Specialist in Obstetrics and Gynecology
  • Versys Clinics
  • Human Reproduction Institute
  • Reprogenex Genetic Diagnostic Laboratory
  • Budapest
  • Hungary
  • Aniruddha Malpani MD
  • Medical Director and Infertility Specialist
  • Malpani Infertility Clinic
  • Mumbai, Maharashtra
  • India
  • Atul Kumar MS Diploma in Adv. Hysteroscopic Surgery
  • Scientific Director
  • Women's Health Center
  • Head, Hysteroscopic Surgery Division
  • Anil Nursing Home
  • Jaipur, Rajasthan
  • India
  • Anjali Malpani MD
  • Infertility Specialist
  • Malpani Infertility Clinic
  • Mumbai, Maharashtra
  • India
  • Aygül Demirol MD
  • Associate Professor
  • Medical Director
  • Gurgan Clinic Women Health
  • Infertility and IVF Center
  • Ankara
  • Turkey
  • Antonio Barbaro
  • Association for the Study of
  • Couple Infertility (ASIC)
  • Rome
  • Italy
  • Barbara Lawrenz MD PhD
  • Specialist in Obstetrics and Gynecology
  • IVI GCC Fertility Center
  • Abu Dhabi
  • UAE
  • Ariel Jaffa MD
  • Professor
  • Senior Physician
  • Department of Obstetrics, Gynecology and Ultrasound
  • Tel Aviv Sourasky Medical Center
  • Tel Aviv
  • Israel
  • Bee K Tan MRCOG
  • Associate Clinical Professor
  • WMS–Reproductive Health
  • University of Warwick
  • Coventry
  • UK
  • Asha Baxi MS FRCOG
  • Obstetrician and Gynecologist
  • Disha Fertility and Surgical Center
  • Indore, Madhya Pradesh
  • India
  • Belén Aparicio-Ruiz PhD
  • Senior Embryologist
  • IVF Unit
  • Instituto Valenciano de Infertilidad (IVI)
  • INCLIVA-Universidad de Valencia
  • Valencia
  • Spain
  • Asha Reddy MD
  • Consultant in Reproductive Endocrinology and Infertility
  • Department of Obstetrics and Gynecology
  • Bhoomi IVF Center
  • Bengaluru, Karnataka
  • India
  • Ben Yosef Dalit PhD
  • Professor
  • Department of Cell and Developmental Biology
  • Tel Aviv Sourasky Medical Center
  • Tel Aviv
  • Israel
  • Ashok Agarwal PhD HCLD (ABB) EMB (ACE)
  • Professor, Lerner College of Medicine
  • Director, Andrology Laboratory
  • Director, Center for Reproductive Medicine, Infertility and Sexual Function
  • Glickman Urological Institute
  • Center for Advanced Research in Human Reproduction
  • The Cleveland Clinic Foundation
  • Cleveland, Ohio
  • USA
  • Benjamin Fisch MD PhD
  • Director
  • Infertility and IVF Unit
  • Rabin Medical Center, Beilinson Hospital
  • Professor, Obstetrics and Gynecology
  • Sackler Faculty of Medicine
  • Tel Aviv University
  • Tel Aviv
  • Israel
  • Bijit Chowdhury MD DGO
  • Obstetrician and Gynecologist
  • MICROLAP
  • Kolkata, West Bengal
  • India
  • Daniel B Williams MD
  • Infertility Specialist
  • Reproductive Endocrinology and Infertility
  • Houston Fertility Institute
  • Volunteer Clinical Professor of Obstetrics and Gynecology
  • University of Texas Medical School Houston
  • Texas
  • USA
  • Bryan Woodward PhD FRCPath
  • Director
  • IVF Consultancy Services
  • Leicester
  • UK
  • Daniel Griffin MD
  • Reproductive Endocrinologist
  • Boston IVF at the Women's Hospital
  • Newburgh, Indiana
  • USA
  • CAM Jansen MD PhD
  • Gynecologist (Retired)
  • Consultant, IVF
  • Department of IVF, Obstetrics and Gynecology
  • Voorburg
  • The Netherlands
  • Daniel S Seidman MD
  • Associate Professor
  • Department of Obstetrics and Gynecology
  • Sheba Medical Center, Tel-Hashomer
  • Sackler School of Medicine
  • Tel-Aviv University
  • Tel Aviv
  • Israel
  • Carlo De Angelis MD
  • Professor
  • Chief, Center for Minimally Invasive Therapy
  • Department of Gynecological Sciences and Perinatology
  • University of Rome, “La Sapienza”, Rome
  • Italy
  • David W Schmidt MD FACOG
  • Lead Physician
  • Center for Advanced Reproductive Services
  • Assistant Clinical Professor
  • Department of Obstetrics and Gynecology
  • Division of Reproductive Endocrinology and Infertility
  • University of Connecticut Health Center
  • Farmington, Connecticut
  • USA
  • Carmen Morales PhD
  • Geneticist
  • Department of Preimplantation Genetic Diagnosis (PGD)
  • The PGD Laboratory
  • Center for Embryo Medicine
  • Kuwait
  • Debjyoti Karmakar MD DNB
  • Senior Resident
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi
  • India
  • Carmen Rubio PhD
  • Laboratory Director
  • PGD Molecular Cytogenetics
  • Igenomix
  • Valencia
  • Spain
  • Diána Debreceni PhD
  • Molecular Biologist and Researcher
  • Reprogenex Molecular Genetic Laboratory
  • Budapest
  • Hungary
  • Claus Yding Andersen MSc DMSc
  • Professor of Human Reproductive Physiology
  • Laboratory of Reproductive Biology
  • The Juliane Marie Center for Women Children and Reproduction
  • University Hospital of Copenhagen and Faculty of Health and Medical Sciences
  • Copenhagen
  • Denmark
  • Dov Feldberg MD
  • Professor
  • Infertility Expert
  • Chairman, The Israeli Society of Psychosomatic Obstetrics and Gynecology
  • Vice Chairman, Helen Schneider Hospital for Women
  • Beilinson and Golda Campuses
  • Rabin Medical Center
  • Tel Aviv University School of Medicine
  • Tel Aviv
  • Israel
  • Eitan Lunenfeld MD MHA
  • Professor and Chairman
  • Division of Obstetrics and Gynecology
  • Soroka University Medical Center
  • Dr Morrie Gelfand Chair in Obstetrics and Gynecology
  • Faculty of Health Sciences, Ben-Gurion University of the Negev
  • Israel
  • Ferran Garcia MD
  • Medical Doctor
  • Andrology Service
  • Institut Marquès
  • Barcelona
  • Spain
  • Elizabeth Puscheck MD
  • Chairperson
  • Department of Obstetrics and Gynecology
  • Wayne State University Medical School
  • Detroit, Michigan
  • USA
  • Foad Azem MD
  • Professor and Director
  • Racine IVF Unit
  • Lis Maternity Hospital
  • Tel Aviv Sourasky Medical Center
  • Tel Aviv
  • Israel
  • Erdal Aktan MD
  • Obstetrician and Gynecologist
  • Ozel Ege Tup Bebek Merkezi
  • (Ege Tup Baby Center)
  • IVF Department
  • Kahramanlar, Izmir
  • Turkey
  • Franco Lisi MD
  • Specialist in Obstetrics and Gynecology
  • Head, Assisted Reproduction Treatment
  • Research Center of Reproductive Medicine
  • Nursing Home, Villa Mafalda
  • Rome
  • Italy
  • Ester Polak de Fried MD
  • Professor
  • Department of Obstetrics and Gynecology
  • University of Buenos Aires (UBA)
  • Director, CER Medical Institute
  • IFFS, Treasurer
  • Buenos Aires
  • Argentina
  • Frank M Köhn MD
  • Professor
  • Department of Dermatology and Allergology
  • Andrologicum München
  • Munich
  • Germany
  • Esther Velilla Garcia PhD
  • Director of Reproductive Biology Service
  • Senior Embryologist and PGD Specialist
  • The PGD Laboratory
  • Barcelona
  • Spain
  • Gautam N 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
  • Felipe Caldiño MD
  • Faculty of Reproductive Medicine
  • Associate Gynecologist
  • CONCIBE Reproducción Asistida
  • Mexico City
  • Mexico
  • Gerardo Ardiles MD
  • Attending Gynecologist
  • Atacama Health Service
  • Atacama
  • Chile
  • Fernando Neuspiller MD
  • Director, IVI
  • Leading Medical Group in Assisted Reproduction
  • Buenos Aires
  • Argentina
  • Goral N Gandhi MSc
  • Laboratory Director
  • Vice President (Operations)
  • Rotunda–The Center for Human Reproduction
  • Mumbai, Maharashtra
  • India
  • Gyöngyvér Téglás BSc
  • Molecular Biologist
  • Reprogenex Molecular Genetic Laboratory
  • Budapest
  • Hungary
  • James Craine BS
  • Obstetrician and Gynecologist
  • Andrology Laboratory Services Inc
  • Chicago, Illinois
  • USA
  • Hemlata Sodhiya DGO FCPS DNB MNAMS (Obstetrics and Gynecology)
  • Obstetrician, Gynecologist and Infertility Specialist
  • Ria Clinic
  • Indore, Madhya Pradesh
  • India
  • Jane M Nani MD FACOG
  • Medical Director of Research and Education
  • Clinical Physician and Partner
  • Center for Collaborative Reproduction
  • Fertility Centers of Illinois
  • Chicago, Illinois
  • USA
  • Hossein G Gholami MD
  • Specialist in Obstetrics and Gynecology
  • President
  • Association for Couple Infertility (ASIC)
  • Rome
  • Italy
  • Jay M Bolnick MD
  • Obstetrician and Gynecologist
  • Division of Reproductive Endocrine and Infertility
  • Department of Obstetrics and Gynecology
  • Wayne State University Medical School
  • Detroit, Michigan
  • USA
  • Hugh C Hensleigh PhD HCLD
  • Director, Reproductive Health Laboratory
  • Department of Obstetrics and Gynecology
  • University of Minnesota
  • Minneapolis
  • USA
  • Jayant G Mehta PhD DipRCPath
  • Subfertility Laboratory Director and Quality Control Manager
  • Queen's Hospital
  • Barking, Havering and Redbridge University Hospitals NHS Trust
  • Rom Valley Way
  • Romford, Essex
  • UK
  • Igal Wolman MD
  • Professor
  • Senior Physician
  • Lis Maternity Hospital
  • Tel Aviv Sourasky Medical Center
  • Tel Aviv University
  • Sackler Faculty of Medicine
  • Tel Aviv
  • Israel
  • Jayaprakash Divakaran PhD
  • IVF Laboratory Director
  • Fakih IVF
  • Abu Dhabi
  • UAE
  • István Szabó MD PhD
  • Obstetrician and Gynecologist
  • Obstetrics and Gynecology Disorders Clinic
  • Faculty of Medicine
  • Semmelweis University
  • Budapest
  • Hungary
  • Jaydip Bhaumik DGO MS DNB MRCOG MPH
  • Consultant
  • Bro Morgannwg NHS Trust
  • Department of Obstetrics and Gynecology
  • Princess of Wales Hospital
  • Bridgend
  • UK
  • Jai B Sharma MD FRCOG (London) FAMS FICOG MFFP DNB FIMSA
  • Professor
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi
  • India
  • Jin Ho Lim MD
  • President
  • Maria Fertility Hospital
  • Seoul
  • South Korea
  • Joseph B Lessing MD
  • Director
  • Department of Obstetrics and Gynecology
  • Lis Maternity Hospital
  • Tel Aviv Medical Center
  • Professor of Obstetrics and Gynecology
  • Sackler Faculty of Medicine
  • Tel Aviv University
  • Tel Aviv
  • Israel
  • Lars Grabow Westergaard MD DMSc
  • Professor
  • Human Reproductive Medicine
  • University of Southern Denmark
  • Fertility Clinic
  • Department of Obstetrics and Gynecology
  • Odense University Hospital
  • Odense
  • Denmark
  • Joshua Lim MS TS (ABB)
  • Senior Embryologist and Technical Supervisor
  • Shady Grove Fertility Reproductive Science Center
  • Rockville, Maryland
  • USA
  • Laura Guadarrama MD
  • Faculty of Reproductive Medicine
  • Associate Gynecologist
  • CONCIBE Reproducción Asistida
  • Mexico City
  • Mexico
  • Kathleen E Tucker PhD HCLD(ABB) ELD(ABB)
  • Certified Senior Clinical Embryologist
  • EU (ESHRE)
  • Consultant, Glendora
  • California
  • USA
  • Leonardo Rinaldi MD
  • Specialist in Gynecology, Cell Biology and Biotechnology
  • Department of Gynecology
  • Cell Biology, Biotechnology
  • IVF Unit
  • RISEL–One Day Medical Center
  • Rome
  • Italy
  • Kemal Ozgur MD
  • Clinic Director
  • Consultant Gynecologist and Obstetrician
  • Antalya IVF
  • Antalya
  • Turkey
  • Luca Dal Prato MD
  • Obstetrician and Gynecologist
  • Tecnobios Procreazione–Center for Reproductive Health, Bologna
  • Italy
  • Kevin Coetzee PhD
  • Scientific Advisor
  • Antalya IVF
  • Antalya
  • Turkey
  • Malcolm Clarke BAppSc (Medical Science) MBA (International Business)
  • Senior Management Systems Assessor
  • Australia
  • Khaled K Abu-Amero PhD
  • Molecular Genetics Laboratory
  • Glaucoma Research Chair
  • Department of Ophthalmology
  • College of Medicine
  • King Saud University
  • Riyadh
  • Kingdom of Saudi Arabia
  • Marcos Meseguer MStat, PhD
  • Scientific Manager–IVF
  • Equipo IVI-Valencia
  • Valencia
  • Spain
  • Krishnendu Gupta DGO MD
  • Professor, Teacher and Visiting Surgeon
  • Vivekananda Institute of Medical Sciences
  • Kolkata, West Bengal
  • Chairman
  • Indian College of Obstetricians and Gynecologists
  • Mumbai, Maharashtra
  • India
  • Marianna Csenki MD
  • Clincal Geneticist
  • Versys Clinics
  • Human Reproduction Institute
  • Budapest
  • Hungary
  • Matthew D VerMilyea PhD HCLD/CC (ABB)
  • Scientific Director
  • Texas Fertility Center
  • Austin, Texas
  • USA
  • Munira Juzer Furniturewala MD DGO FCPS
  • Specialist Obstetrician and Gynecologist
  • Specialist in Reproductive Endocrinology and Fertility
  • Mediclinic Dubai Mall
  • The Dubai Mall, Dubai
  • UAE
  • Michael H Fakih MD
  • Consultant Obstetrician and Gynecologist
  • Co-founder and Medical Director
  • IVF Michigan, USA
  • Fakih IVF
  • Dubai
  • UAE
  • Nazar N Amso PhD (London) FRCOG FHEA
  • Professor and Head
  • Department of Obstetrics and Gynecology
  • Director, Ultrasound Masters Program
  • Cardiff University School of Medicine
  • Deputy Director, Engagement
  • Learning and Teaching Institute for Translation Innovation, Methodology and Engagement
  • Cardiff
  • UK
  • Michael J Tucker PhD HCLD FIBiol
  • IVF Laboratory Director
  • Shady Grove Fertility Reproductive Science Center
  • Rockville, Maryland
  • USA
  • Nico Naumann MD
  • Obstetrician and Gynecologist
  • Margherita Medical Center
  • Rome
  • Italy
  • Milica Ivanovic BA BS
  • Embryologist
  • Andrology Laboratory Services Inc
  • Chicago, Illinois
  • USA
  • Nirmala Sadasivam MD PhD
  • Obstetrician, Gynecologist and Infertility Specialist
  • Genesis Fertility Research Center
  • Maaruthi Medical Center and Hospitals
  • Erode, Tamil Nadu
  • India
  • Mirudhubashini Govindarajan FRCSC
  • Director
  • Assisted Reproductive Technology Center
  • Women's Center
  • Coimbatore, Tamil Nadu
  • India
  • Nona Morgan Swank RN BSN
  • IVF Nurse Co-ordinator
  • Advanced Assisted Reproductive Technologies Program
  • Department of Obstetrics and Gynecology
  • Barnes-Jewish Hospital
  • Washington University Medical Center
  • St Louis, Missouri
  • USA
  • Monica Antinori MD
  • Medical Staff
  • Assisted Reproduction Center
  • RAPRUI Day Hospital (International Associated Research
  • Institute for Human Reproduction)
  • Rome
  • Italy
  • Nwora A Melie DipRCPath
  • Chief Embryologist
  • Assisted Conception Unit
  • Bridge Clinic Ltd
  • Victoria Island, Lagos
  • Nigeria
  • Monikaa M Chawla MD FRCOG (UK)
  • Reproductive Endocrinologist and Fertility Specialist
  • Obstetrician and Gynecologist
  • Fakih IVF
  • Abu Dhabi and Dubai
  • UAE
  • Otto Kabdebo MD
  • Chief Obstetrician and Gynecologist
  • Clinic Dr Krüsmann
  • Munich-Pasing
  • Co-founder
  • Endoscopy Center
  • Munich
  • Germany
  • MS Lakshmi MBBS DNB
  • Consultant in Reproductive Medicine
  • Women's Center
  • Sri Ramakrishna Hospital Campus
  • Coimbatore, Tamil Nadu
  • India
  • Padma Rekha Jirge MRCOG (UK) FICOG
  • Scientific Director
  • Shreyas Hospital
  • Kolhapur, Maharashtra
  • India
  • Pankaj Shrivastav MD DGO MRCOG
  • Director
  • Consultant, Reproductive Endocrinology and Fertility
  • Consultant Obstetrician and Gynecologist
  • Conceive–The Gynecology and Fertility Hospital, Sharjah
  • Conceive–The Gynecology Center, Dubai
  • UAE
  • Puneet Rana Arora MD
  • Consultant Reproductive Medicine Specialist
  • Nova IVI Fertility
  • New Delhi
  • India
  • Col Pankaj Talwar VSM
  • Professor and Head
  • Department of Obstetrics and Gynecology
  • Assisted Reproductive Technologies Center
  • INHS ASVINI
  • Mumbai, Maharashtra
  • India
  • Radha Syed MD FACOG
  • Obstetrics and Gynecologist
  • Specialist in Minimally Invasive Gynecological
  • Surgery and Robotics
  • Richmond Aesthetics in Gynecology
  • Staten Island, New York
  • USA
  • Pere Mir Pardo PhD Laboratory Director Central Laboratory Igenomix Valencia
  • Spain
  • Rafael C Haciski MD FACOG
  • Gynecologist
  • Department of Obstetrics and Gynecology
  • Advanced Gynecology Inc
  • Naples, Florida
  • USA
  • Peter Kovacs MD PhD
  • Medical Director
  • Kaali Institute IVF Center
  • Budapest
  • Hungary
  • Rajasingam S Jeyendran BVSc MS PhD HCLD ALD
  • Director
  • Andrology Laboratory Services Inc
  • Chicago, Illinois
  • USA
  • PM Rijnders MSc
  • Embryologist and Laboratory Director
  • Department of IVF
  • Reinier de Graaf Groep
  • Department of Obstetrics and Gynecology
  • Voorburg
  • The Netherlands
  • Rakesh K Sharma PhD
  • Associate Professor
  • Lerner College of Medicine
  • Co-ordinator of Andrology Laboratory and
  • Center for Reproductive Medicine
  • Glickman Urological and Kidney Institute
  • Cleveland Clinic
  • Cleveland, Ohio
  • USA
  • Pratik Tambe MD FICOG
  • Consultant and Endoscopic Surgeon
  • Nirmiti Fertility and IVF
  • Mumbai, Maharashtra
  • India
  • Rakesh Sinha MD DGO Diploma in Gynecological Endoscopy
  • Laparoscopic and Robotic Surgeon
  • Founder Beams Hospitals
  • Women's Hospitals
  • Mumbai, Maharashtra
  • India
  • Priyanka Pangerkar MSc
  • Embryologist
  • Rotunda–The Center for Human Reproduction
  • Mumbai, Maharashtra
  • India
  • Ramesh B MD
  • Chief Infertility Specialist
  • Dr Ramesh Hospital
  • High Tech Superspecialty Hospital for Gynecology, Laparoscopy, and Infertility
  • Rajajinagar
  • Bengaluru, Karnataka
  • India
  • Ran Keidar MD
  • Obstetrician and Gynecologist
  • Ultrasound Unit
  • Department of Obstetrics and Gynecology
  • Edith Wolfson Medical Center
  • Holon, Tel Aviv
  • Israel
  • Roy Mashiach MD
  • Vice Chair
  • Department of Gynecology
  • Sheba Medical Center
  • Tel Hashomer
  • Israel
  • Randall R Odem MD
  • Professor of Obstetrics and Gynecology
  • Chief, Reproductive Endocrinology
  • Division of Reproductive Endocrinology and Infertility
  • Fertility Reproductive Medical Center
  • Washington University School of Medicine
  • St Louis, Missouri
  • USA
  • Rubina Merchant PhD
  • Embryologist
  • Rotunda–The Center for Human Reproduction
  • Mumbai, Maharashtra
  • India
  • Raoul Orvieto MD MMSc
  • Professor and Director
  • Infertility and IVF Unit
  • Department of Obstetrics and Gynecology
  • Barzilai Medical Center, Ashkelon, and Faculty of Health Sciences
  • Ben-Gurion University of the Negev
  • Beersheba
  • Israel
  • Rupin Shah MS (Surgery) MCh (Urology)
  • Consultant Andrologist and Microsurgeon
  • Lilavati Hospital and Research Center
  • Mumbai, Maharashtra
  • India
  • Raquel García PhD
  • Molecular Biologist
  • Department of Preimplantation Genetic Diagnosis (PGD)
  • Center for Embryo Medicine
  • Barcelona
  • Spain
  • Ruslan Valentinovich Sobolev MD PhD
  • Obstetrician, Gynecologist and Reproductive Medicine Specialist
  • Head, Department of Assisted Reproduction
  • Mother and Child Clinic
  • ADONIS Medical Group
  • Odessa
  • Ukraine
  • Richard A Ajayi MD
  • Consultant Gynecologist and Director
  • The Assisted Conception Unit
  • The Bridge Clinic Limited
  • Lagos
  • Nigeria
  • Rutvij Dalal DGO DNB FNB
  • Consultant in IVF and Endoscopy
  • Lilavati Hospital
  • Mumbai, Maharashtra
  • India
  • Ritu Hinduja Singh MD DRM (Germany) Fellowship in Reproductive Medicine (India, Spain, Israel)
  • Consultant Reproductive Medicine
  • Nova IVI Fertility
  • Mumbai, Maharashtra
  • India
  • Sajal Datta MD DNB
  • Visiting Obstetrician and Gynecologist
  • Columbia Asia Hospital, Salt Lake
  • Professor and Lecturer
  • Vivekananda Institute of Medical Sciences
  • Honorary Visiting Surgeon
  • Department of Obstetrics and Gynecology
  • Ramkrishna Mission Seva Prathishthan Hospital
  • Kolkata, West Bengal
  • India
  • Roelof Menkveld, PhD
  • Professor Emeritus
  • Department of Obstetrics and Gynecology
  • Faculty of Medicine and Health Sciences
  • Stellenbosch University
  • Tygerberg
  • South Africa
  • Sakina Kagalwala MSc
  • Senior Embryologist
  • Rotunda–The Center for Human Reproduction
  • Mumbai, Maharashtra
  • India
  • (Late) Samuel S Thatcher MD PhD
  • Center for Applied Reproductive Science (CARS)
  • Johnson City, Tennessee
  • USA
  • Sarah L Keller MD
  • Assistant Professor
  • Department of Obstetrics and Gynecology
  • Division of Reproductive Endocrinology
  • Barnes-Jewish Hospital
  • Washington University Medical Center
  • St Louis, Missouri
  • USA
  • San Hyun Yoon PhD
  • Manager
  • Department of IVF Research
  • Maria Research Center
  • Seoul
  • South Korea
  • Sarit Avraham MD
  • Obstetrician and Gynecologist
  • Department of Obstetrics and Gynecology
  • Tel Aviv Sourasky Medical Center
  • Chaim Sheba Medical Center, and Sackler School of Medicine
  • Tel Aviv University
  • Tel Aviv
  • Israel
  • Sana N Khan MD
  • Obstetrician and Gynecologist
  • Division of Reproductive Endocrine and Infertility
  • Department of Obstetrics and Gynecology
  • Wayne State University Medical School
  • Detroit, Michigan
  • USA
  • Sheetal Sawankar DNB MNAMS DRM (Germany)
  • Consultant Fertility Specialist
  • Seven Hills Hospital
  • Mumbai, Maharashtra
  • India
  • Sandra Cubillos BS
  • Embryologist
  • IVF Laboratory Director
  • Concibe Reproducción Asistida
  • Mexico City
  • Mexico
  • Shlomo Mashiach MD
  • Obstetrician and Gynecologist
  • IVF Unit
  • Assuta Medical Center
  • Department of Obstetrics and Gynecology
  • Chaim Sheba Medical Center
  • Tel-Hashomer and Sackler School of Medicine
  • Tel Aviv University
  • Tel Aviv
  • Israel
  • Sandra K Dill AM
  • CEO and Managing Director
  • ACCESS Australia's National Infertility Network Ltd
  • Non-profit Organization Management
  • International Consumer Support for
  • Infertility (iCSi) Patient Leader Network
  • Chair, ACT Global Taskforce
  • Co-ordinator, ESHRE Patient Leader Forum
  • New South Wales
  • Australia
  • Shraddha Shetye-Kapdi MSc
  • Clinical Embryologist
  • Seven Hills Hospital
  • Mumbai, Maharashtra
  • India
  • Sanjay C Wagle MD MRCP
  • Critical Care Physician
  • Bombay Hospital and Medical
  • Research Center
  • Mumbai, Maharashtra
  • India
  • Sigal Klipstein MD
  • InVia Fertility Specialists
  • Hoffman Estates
  • University of Chicago
  • Chicago, Illinois
  • USA
  • Silvia F Fernández MSc
  • Director
  • Molecular Cytogenetics Laboratory
  • Specialist in Assisted Human Reproduction and Clinical Embryology
  • Center for Embryo Medicine
  • Barcelona
  • Spain
  • Suneeta Mittal MD FRCOG(AE) FICOG FAMS FICMCH FIMSA FICLS
  • Professor, Director and Head
  • Department of Obstetrics and Gynecology
  • Fortis Memorial Research Institute
  • Gurgaon, New Delhi
  • India
  • Silvia Modamio PhD
  • Manager, Molecular Biology Laboratory
  • Specialist in Preimplantation Genetic Diagnosis
  • Center for Embryo Medicine
  • Unidad de Genética Molecular
  • Hospital Ramón y Cajal
  • Centro de Investigación Biomédica en Red de Enfermedades
  • Raras (CIBERER), ISCIII
  • Madrid
  • Spain
  • Swati G Allahbadia MD DGO DGE (Germany)
  • Director
  • Consultant Obstetrician, Gynecologist and Endoscopist
  • Rotunda Blue Fertility Clinic and Keyhole Surgery Center
  • Rotunda Hospital
  • Global Hospital
  • Visiting Gynecologist
  • Nowrosjee Wadia Maternity Hospital
  • Breach Candy Hospital
  • SL Raheja (Fortis) Hospital
  • Mumbai, Maharashtra
  • India
  • Silvio Cuneo MD
  • Associate Gynecologist
  • Faculty of Reproductive Medicine
  • Concibe Reproducción Asistida
  • Mexico City
  • Mexico
  • Tali Silberstein MD
  • Obstetrician and Gynecologist
  • Department of Obstetrics and Gynecology
  • Soroka Medical Center
  • Ben-Gurion University of the Negev
  • Beersheba
  • Israel
  • Siya S Sharma MD DNB DGO MRCOG
  • Specialist
  • Addenbrookes Hospital
  • Cambridge
  • UK
  • Timur Gürgan MD
  • Professor and Section Head
  • Division of Reproductive Endocrinology and Infertility
  • Andrology Unit
  • Department of Obstetrics and Gynecology
  • School of Medicine, Hacettepe University
  • Scientific Director
  • Gurgan Clinic Women's Health
  • Infertility and IVF Center
  • Ankara
  • Turkey
  • Sucheta Jindal MD MRCOG
  • Specialist
  • Basildon University Hospital
  • Essex
  • UK
  • Umesh Acharya BM DM FRCOG
  • Consultant in Obstetrics, Gynecology and Reproductive Medicine
  • South West Center for Reproductive Medicine
  • Derriford Hospital
  • Plymouth
  • UK
  • Sudip Basu MD DNB MRCOG MRCPI CCT (UK)
  • Consultant, Gynecologist and Infertility Specialist
  • Kolkata, West Bengal
  • India
  • Valery Mycolayovych Zaporozhan
  • DMedSc MD DM
  • Professor, Honored Inventor of Ukraine
  • Rector of Odessa State Medical University
  • Obstetrician and Gynecologist
  • Odessa State Medical University
  • Odessa
  • Ukraine
  • Vanesa Morales MD
  • Associate Gynecologist
  • Faculty of Reproductive Medicine
  • Concibe Reproducción Asistida
  • Mexico City
  • Mexico
  • Weon Young Son PhD
  • IVF Laboratory Director
  • Reproductive Center
  • Department of Obstetrics and Gynecology
  • Royal Victoria Hospital
  • Montreal
  • Canada
  • Ved Prakash Singh MD
  • Consultant
  • Waikato Hospital
  • Associate Medical Director
  • Fertility Associates
  • Hamilton
  • New Zealand
  • Wolf Bernhard Schill MD Professor and Chairman
  • Center of Dermatology and Andrology
  • Justus Liebig University
  • Giessen
  • Germany
  • Vijay Kulkarni MS
  • Consultant Andrologist and Microsurgeon
  • Dr Kulkarni's Clinic
  • Honorary Andrologist
  • LTM Medical College and LTMM General Hospital
  • Bhatia General Hospital
  • SL Raheja Hospital and All India Institute for Diabetes
  • Parakh Hospital and IVF Center
  • Prince Aly Khan Hospital
  • The National lnstitute for Research in Reproductive Health (ICMR)
  • Mumbai, Maharashtra
  • India
  • Yona Tadir MD
  • Director of Clinical Research
  • Professor, Department of Obstetrics and Gynecology
  • Beckman Laser Institute
  • University of California Irvine
  • Irvine, California
  • USA
  • Vishvanath C Karande MD
  • President and Medical Director
  • IVF Program
  • InVia Fertility Specialists
  • Hoffman Estates
  • Illinois
  • USA
  • Yousef M Alhelou MSc TS (ABB)
  • Embryologist
  • Fakih IVF
  • Abu Dhabi
  • UAE
  • Vladlena Gennadiivna Dubinina MD DM
  • Professor, Vice Rector
  • Head of Oncology Department
  • Obstetrician and Gynecologist
  • Odessa State Medical University
  • Odessa
  • Ukraine
  • Zeev Blumenfeld MD
  • Associate Professor
  • Director, Reproductive Endocrinology
  • Chairman, Department of Obstetrics and Gynecology
  • Rambam Medical Center
  • Curriculum, Technion–Faculty of Medicine
  • Haifa
  • Israel
fm8 fm9 fm10 fm11 fm12 fm13 fm14 fm15 fm16 fm17 fm18 fm19Foreword
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.
fm20
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