Оглавление
Группа авторов. Assisted Reproduction Techniques
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Assisted reproduction techniques. Challenges and management options
Contributors
Preface to the second edition
Preface to the first edition
How to use this book
Abbreviations
1 Risk of cancer from ovarian stimulation
Background
Management options. Breast cancer
Ovarian cancer
Endometrial cancer
Cervical cancer
Key points
Answers to questions patients ask
References
2 Risk of early menopause following IVF treatment
Background
Management options
Key points
Answers to questions patients ask
References
3 The HIV‐positive female
Background
Management options
Key points
Answers to questions patients ask
References
4 The HIV‐positive male
Background
Management options
Prevention
Key points
Answers to questions patients ask
References
5 The hepatitis B or C carrier patient
Background. Hepatitis B
Hepatitis C
Management of patients. Hepatitis B
Hepatitis C
Prevention
Key points
Answers to questions patients ask
References
6 The patient with cystic fibrosis
Background
Management options
Diagnosis and counseling
Case history 1
Case history 2
Treatment options
Case history 1
Case history 2
Ethical considerations
The future
Key points
Answers to questions patients ask
References
7 The patient on medication
Background
Management options. Drugs in the preconception stage and early pregnancy
Drugs in women undergoing ART
Herbal medications in patients undergoing ART
Key points
Answers to questions patients ask
References
8 The patient with thrombophilia
Background
Thrombotic disorders. Inherited thrombophilia
Acquired thrombophilia
Management options
Box 8.1 Clinical and laboratory criteria for the diagnosis of antiphospholipid syndrome. Clinical criteria
Laboratory criteria
Post IVF follow‐up
Key points
Answers to questions patients ask
References
9 The patient with autoimmune disorders
Background
Management options
Pregnancy and SLE
Key points
Answers to questions patients ask
References
10 The patient with malignant disease: fertility preservation
Background
Management options
Ovarian tissue cryopreservation (OTC)
Controlled ovarian stimulation and cryopreservation of oocytes or embryos
GnRH agonist co‐treatment during chemotherapy
Sperm banking
Key points
Answers to questions patients ask
References
11 The patient with heart disease
Background
Management options
Ischemic heart disease
Cardiomyopathy
Valve disease
Key points
Answers to questions patients ask
References
12 The patient with diabetes
Background
Management options
Female with diabetes
Females with bariatric surgery
Male with diabetes
Prevention
Key points
Answers to questions patients ask
References
13 The patient with thyroid disease
Background
Hypothyroidism
Hyperthyroidism
Management options
Hypothyroidism
Hyperthyroidism
Key points
Answers to questions patients ask
References
14 The patient with hyperprolactinemia
Background
Causes of hyperprolactinemia
Physiological causes
Pharmacological causes
Pathological causes
Investigation of hyperprolactinemia
Management options
Fertility, pregnancy and prolactinoma
Hyperprolactinemia and fertility
Safety of dopamine agonists
Tumor growth
Lactation
Key points
Answers to questions patients ask
References
15 The patient with polycystic ovaries
Background
Management options
The long GnRH agonist protocol
The GnRH antagonist protocol
Key points
Answers to questions patients ask
References
16 The renal transplant patient
Background
Risks of IVF and the graft recipient
Risks to the fetus
Risk from immunosuppression
Maternal risks in pregnancy
Management options
Key points
Answers to questions patients ask
References
17 The patient with previous pelvic irradiation
Background
Ovarian dysfunction
Investigation of ovarian function
Uterine dysfunction
Investigation of uterine function
Pregnancy outcomes
Prevention. Ovarian transposition (oophoropexy)
Fertility preservation techniques (see chapter 10)
Key points
Answers to questions patients ask
References
18 Female fertility after chemotherapy
Background
Effects of chemotherapy
Ovarian function after chemotherapy
Timing to conception after chemotherapy
Management options
Assessment of ovarian reserve
Early recourse to assisted reproduction techniques (ART)
Prepregnancy counseling
Pregnancy after chemotherapy
Prevention
Key points
Answers to questions patients ask
References
19 The patient with abnormal cervical cytology
Background
Management options
Low‐grade lesions
High‐grade lesions
Glandular abnormalities
Key points
Answers to questions patients ask
References
20 The patient with previous borderline ovarian tumor
Background
Management options
Key points
Answers to questions patients ask
References
21 The patient with an endometrioma
Background
Management options
Key points
Answers to questions patients ask
References
22 The patient with cervical stenosis
Background
Management options. Take a precise history
Mock embryo transfer
Cervical dilatation
Transmyometrial embryo transfer
Tubal embryo transfer
Hysteroscopic canalization of the cervix
Postponing ET
Key points
Answers to questions patients ask
References
23 Vaccination and ART
Background
Management options. Vaccinations
Malaria prophylaxis
H1N1 vaccination and pregnancy
Key points
Answers to questions patients ask
References
24 The patient with hydrosalpinx
Background
Management options
Salpingectomy
Tubal occlusion
Transvaginal aspiration
Prevention
Key points
Answers to questions patients ask
References
25 The patient with hydrosalpinx and contraindication to laparoscopy
Background
Management options. Hysteroscopic options. Hysteroscopic tubal occlusion using Essure microinsert
Hysteroscopic tubal electrocoagulation
Ultrasound guided tubal occlusion. Ultrasound guided aspiration of the hydrosalpinx
Ultrasound guided aspiration followed by sclerotherapy
Embolization of the hydrosalpinx
Key points
Answers to questions patients ask
References
26 The patient with reduced ovarian reserve
Background. Ovarian reserve
Management options. Anti‐Müllerian hormone as a marker of ovarian reserve
Strategies to improve ovarian response. Gonadotropin dose, type and timing
Gonadotropin releasing hormone agonists and antagonists
Alternative approaches and adjuvant therapy
Key points
Answers to questions patients ask
References
27 The patient with congenital uterine anomalies
Background
Management options. Aplastic uterus
Hemi‐uterus (formerly unicornuate uterus)
Partial bicorporeal uterus (formerly bicornuate uterus)
Complete bicorporeal uterus with double cervix (formerly uterus didelphys)
Septate uterus
Key points
Answers to questions patients ask
References
28 The patient with congenital cervico‐vaginal anomalies
Background
Management options. Imperforate hymen
Vaginal septum. Transverse vaginal septum
Longitudinal vaginal septum
Vaginal agenesis
Cervical agenesis
Management for case histories
Key points
Answers to questions patients ask
References
29 The patient with uterine fibroids
Background
Diagnosis of fibroids
Fibroids and infertility
Management options. Submucosal fibroids
Intramural fibroids
Case discussion
Key points
Answers to questions patients ask
References
30 The patient with adenomyosis
Background
Management options. Adenomyosis and intrauterine insemination (IUI)
Adenomyosis and IVF
Key points
Answers to questions patients ask
References
31 The patient with previous Essure® sterilization
Background
Hysteroscopic Essure® sterilization
Length and location of tubal occlusion
Foreign body within the uterine cavity
Management options. Reversal of Essure® sterilization
Assisted conception treatment
Key points
Answers to questions patients ask
References
32 The patient with previous endometrial ablation
Background
Management options. Counseling
Evaluation of the uterine cavity and hysteroscopic adhesiolysis
Assisted conception after endometrial ablation
Key points
Answers to questions patients ask
References
33 The couple with recurrent implantation failure
Background
Management options. Causes
Additional factors
Treatments
Key points
Answers to questions patients ask
References
34 The patient with previous uterine artery embolization
Background
Menstrual symptoms following UAE
Reproductive outcomes following UAE
Management options. International recommendations
Case management
Key points
Answers to questions patients ask
References
35 The patient with endometrial polyp
Background
Management options. Polyps and intrauterine insemination
Polyps and IVF
Polypoid endometrium
Prevention
Key points
Answers to questions patients ask
References
36 The obese female patient
Background
Management options
Key points
Answers to questions patients ask
References
37 The patient with Asherman syndrome
Background
Management options. Removal of adhesions
Endometrial restoration and prevention of recurrence
Prevention
Key points
Answers to questions patients ask
References
38 The older patient
Background
Management options. Advanced maternal age (case history 1)
Advanced paternal age (case history 2)
Prevention
Key points
Answers to questions patients ask
References
39 Requests for mild or natural cycle IVF treatment
Background
Management options
Key points
Answers to questions patients ask
References
40 The patient with psychosexual problems
Background
Barriers to disclosure
Women
Men
History and assessment
Frequency and timing of intercourse
Pain or difficulty with penetration
Other sexual dysfunctions
Psychosexual examination
Management options. Psychoeducation
Lubricants
Lignocaine/Lidocaine
Vaginal trainers
Psychosexual therapy
Physiotherapy
Botulinum toxin
Management of men with psychosexual problems
Erectile dysfunction
Premature ejaculation
Undertaking ART in a woman with psychosexual problems
Key points
Answers to questions patients ask
References
41 The patient needing third‐party reproduction
Background
Management options
Sperm donation
Oocyte donation
Surrogacy
Uterine transplantation
Key points
Answers to questions patients ask
References
42 Social oocyte freezing
Background
Management options
Realistic chances of success
Process of oocyte freezing and future use
Duration of oocyte storage
Treatment risks
Potential benefits
Cost of treatment
Alternative options to oocyte freezing
Likelihood of using vitrified oocytes
Conclusion
Key points
Answers to questions patients ask
References
43 The male and female patients following bariatric surgery
Background
Management options
Key points
Answers to questions patients ask
References
44 Endometrial receptivity testing
Background
Endometrial receptivity and selectivity
Management options. Testing endometrial selectivity and receptivity
Ultrasound
Endometrial biopsy and fluid aspirate
Hysteroscopy
Key points
Answers to questions patients ask
References
45 Poor response during ovarian stimulation
Background
Management options
Management of women with one or two mature follicles (case history 1)
Management of women with no follicular recruitment
Subsequent cycles
Key points
Answers to questions patients ask
References
46 Ovarian stimulation for IVF in a patient at high risk of ovarian hyperstimulation syndrome
Background
Management options. Take a precise history
GnRH antagonist protocol
Milder ovarian stimulation
Co‐administration of metformin in long agonist protocol cycles
GnRH agonist trigger in antagonist cycles
Avoid hCG for luteal support
Cryopreservation of all embryos
Patient counseling
Key points
Answers to questions patients ask
References
47 Unable to achieve pituitary down‐regulation
Background
Defining successful down‐regulation
Management options
Pregnancy
Elevated estradiol levels
Functional ovarian cysts
Intractable non‐down‐regulation
Thickened endometrium
Key points
Answers to questions patients ask
References
48 The patient discovered pregnant during pituitary down‐regulation
Background
Miscarriage and ectopic pregnancy
Teratogenicity
Long‐term effects on the offspring
Management options
Prevention
Key points
Answers to questions patients ask
References
49 Ovarian cysts following pituitary down‐regulation
Background
Mechanism of cyst formation
Type of GnRHa and protocol used
Impact of ovarian cysts
Management options
Case history 1
Case history 2
Prevention
Key points
Answers to questions patients ask
References
50 Missed IVF medications
Background
Gonadotropin‐releasing hormone agonists
Gonadotropin‐releasing hormone antagonists
Human menopausal gonadotropin (hMG) and recombinant follicle‐stimulating hormone (rFSH)
Human chorionic gonadotropin (hCG)
Progesterone and progestogens
Prevention
Key points
Answers to questions patients ask
References
51 The ART patient with a history of estrogen‐receptor positive cancer
Background
Management options
Prevention
Key points
Answers to questions patients ask
References
52 The patient over‐responding to controlled ovarian stimulation during IVF
Background
Management options. Assess the chance of OHSS developing
Cycle cancelation
Coasting
GnRH antagonist rescue
Reducing the hCG dose
GnRH agonist trigger in antagonist cycles
Dopamine agonists
Intravenous albumin
Avoid hCG for luteal support
Cryopreservation of all embryos (freeze‐all)
Patient counseling
Case management
Key points
Answers to questions patients ask
References
53 General anesthesia or sedation for oocyte retrieval?
Background
Management options
Sedation
Patient controlled analgesia (PCA)
General anesthesia
Regional anesthesia
Paracervical block
Suggested case management
Key points
Answers to questions patients ask
References
54 Delayed oocyte retrieval
Background
Management options
Cancel the oocyte retrieval and the cycle
Perform oocyte retrieval if there are no signs of ovulation
Prevention
Suggested case management
Key points
Answers to questions patients ask
References
55 Empty follicle syndrome
Background
Management options. Predicting EFS
Diagnosis EFS at oocyte retrieval
Urine hCG measurement
Rescue trigger in hCG‐triggered cycles
Rescue trigger in GnRH agonist‐triggered cycles
Counseling
Prevention
Key points
Answers to questions patients ask
References
56 Bleeding following oocyte retrieval
Background
Vaginal bleeding
Intra‐abdominal bleeding
Management options. Vaginal bleeding
Intra‐abdominal bleeding
Prevention
Key points
Answers to questions patients ask
References
57 To flush or not to flush follicles at oocyte retrieval
Background
Management options. Follicle flushing in normal responders
Follicle flushing in poor responders
Effect of follicle flushing on procedure time
Conclusions
Key points
Answers to questions patients ask
References
58 Inaccessible ovaries at oocyte retrieval
Background
Management options. Empty bladder
Manipulation, positioning and abdominal pressure
Tenaculum
Transvaginal transmyometrial oocyte retrieval
Transabdominal ultrasound‐guided retrieval
Transvesical transurethral ultrasound‐guided retrieval
Laparoscopic oocyte retrieval
Prevention. History
Transvaginal ultrasound scan examination
Identification, counseling and planning
Ovarian mobilization
Key points
Answers to questions patients ask
References
59 Endometriotic cysts at oocyte retrieval
Background
Management options
To puncture or not to puncture the endometrioma at oocyte retrieval
To aspirate or not to aspirate the endometrioma at oocyte retrieval
Prevention. To remove or not to remove endometriomas prior to IVF
Risks of surgery
Risks of expectant management
Effect on ovarian response
Effect on ART outcome
Conclusion
Key points
Answers to questions patients ask
References
60 Inadvertent injury during oocyte retrieval
Background
Management options
Bowel injury
Urinary tract injury. Ureter
Bladder
Nerve injury
Vertebral injury
To transfer or to freeze‐all?
Prevention. Pre‐TVOR assessment
TVOR technique
Transabdominal ultrasound‐guided retrieval
Key points
Answers to questions patients ask
References
61 Dealing with equipment failure during oocyte retrieval
Background
Management options. Recognition of equipment failure
Occlusion of the aspiration needle
Slow aspiration rate
Follicular fluid overflow
Manual aspiration
Clear communication in theater
Documenting and reporting equipment failure
Prevention
Adequate number and well‐maintained equipment
Preoperative equipment check
Well‐rehearsed back‐up plan
Key points
Answers to questions patients ask
References
62 How many embryos to transfer?
Background
Published trend data
Professional bodies recommendations
Management options
Multiple birth minimization strategy (MBMS)
Blastocyst transfer
Time‐lapse
Preimplantation genetic testing for aneuploidy (PGT‐A)
Embryo cryopreservation
Borderline prognosis
Prevention. Patient counseling and education
Suggested case management
Key points
Answers to questions patients ask
References
63 Poor endometrial development in ART
Background
Causes of thin endometrium
Investigations to assess the endometrium. Patient’s history
Ultrasound
Power Doppler ultrasound
Three‐dimensional ultrasound
Hormonal assessment
Hysteroscopy
Management options. Thin endometrium in fresh IVF cycles
Thin endometrium in frozen‐thawed IVF cycles
Adjuvants
Hormonal adjuvants
Vascular adjuvants to improve uterine blood flow
Growth factors
Resolutions of case histories
Key points
Answers to questions patients ask
References
64 Endometrial cavity fluid identified during IVF treatment
Background
Management options
Continue treatment
Freeze embryos
Hydrosalpinx and ECF aspiration
Prevention
Key points
Answers to questions patients ask
References
65 Difficult embryo transfer
Background
Management options. Filling the urinary bladder
Using a tenaculum
Using a rigid catheter
Ultrasound guidance
Transmyometrial embryo transfer
Technique
Results
Pros and cons
Tubal embryo transfer
Getting help from another colleague
Cryopreserving the embryos
Prevention. Obtain a precise history
Mock ET
Clinic‐specific ET protocol
Key points
Answers to questions patients ask
References
66 Excess cervical mucus and retained embryos at embryo transfer
Background
Management options. To remove or not to remove excess cervical mucus
To flush or not to flush the cervical canal
Embryos retained in the transfer catheter
Prevention
Key points
Answers to questions patients ask
References
67 Life after embryo transfer
Background
Management options. Physical activity post transfer and IVF success. Exercise after ET
Bed rest after embryo transfer
Sexual intercourse after embryo transfer
Impact of diet on IVF success
Stress reduction activities
Prevention
Key points
Answers to questions patients ask
References
68 Vaginal bleeding in the luteal phase after IVF
Background
Luteal phase in the natural cycle
Luteal phase in stimulated ART cycles
Management options. Checking compliance with luteal phase support medications
Changing the luteal phase support medications
Patient information
Prevention
Duration of luteal phase support
Progesterone
Progesterone and estradiol
Human chorionic gonadotropin
Key points
Answers to questions patients ask
References
69 Pelvic infection after IVF
Background
Management options. Considering and making the diagnosis
Antimicrobial therapy
Drainage of abscess and eradication of the focus of infection
Salvaging the IVF cycle
Prevention
Key points
Answers to questions patients ask
References
70 The patient presenting with ovarian hyperstimulation syndrome
Background
Management options
Making the correct diagnosis
Assessing the severity of OHSS
Outpatient vs. inpatient management
Management of symptoms
Thromboprophylaxis
Hydration
Drainage of third‐space fluid collection
Avoiding hCG for luteal support
Cryopreservation of all embryos
Surgical management
Management of complications
Pregnancy outcome after OHSS
Prevention
Key points
Answers to questions patients ask
References
71 Adnexal torsion after IVF
Background
Management options. Diagnosis
Treatment
Prevention
Key points
Answers to questions patients ask
References
72 Exposure to infection in the luteal phase of IVF
Background
Management options. Pelvic infections
Systemic infections
Case history 1: Varicella zoster virus (VZV)
Vaccination
Resolution of case history 2
Priority and emerging pathogens
H1N1
Zika
COVID‐19
Key points
Answers to questions patients ask
References
73 Total failure of fertilization after conventional IVF – rescue ICSI
Background
Management options
The Genesis Fertility Center experience
New concepts in R‐ICSI – can we do better?
Prevention. Prevention of recurrence
Split insemination in unexplained infertility
ICSI for all?
Key points
Answers to questions patients ask
References
74 Couples not wishing to create surplus embryos in IVF
Background
Management options. Effect of decision on outcome
Natural cycle IVF
Modified natural cycle IVF
Minimal stimulation IVF
Inseminating a limited number of oocytes and cryopreserving the rest
Compassionate transfer
Prevention
Key points
Answers to questions patients ask
References
75 Routine preimplantation genetic testing for aneuploidy
Introduction
Management options. PGT‐A in AMA
PGT‐A in RIF
PGT‐A in good prognosis patients
Limitations of PGT
What to do?
Key points
Answers to questions patients ask
References
76 Choosing an embryo for transfer
Background
Management options. Selection based on morphology
Pronuclear scoring
Cleavage stage scoring
Blastocyst scoring
Preimplantation genetic testing for aneuploidy (PGT‐A)
Time‐lapse (TL) technology
Metabolomics and proteomics
Key points
Answers to questions patients ask
References
77 Globozoospermia
Background
Management options. ICSI
Oocyte activation and ICSI
How to proceed
Patient counseling
Key points
Answers to questions patients ask
References
78 Total failure of fertilization after ICSI
Background
Effect of oocyte number
Effect of sperm
Management options. Rescue oocyte activation
Calcium ionophore (A23187) treatment
Prevention
Key points
Answers to questions patients ask
References
79 Refreezing of embryos
Background
Management options. Refreezing embryos at various developmental stages
Embryo biopsy plus refreezing
Oocyte freezing and subsequent embryo freezing
Embryo donation and refrozen embryos
Clinical application
Key points
Answers to questions patients ask
References
80 Infection in embryo culture medium
Background
Management options
Detection
How to proceed. Bacterial infection
Yeast contamination
Prevention. General measures
Minimizing handling
Semen processing
Prevention of recurrence
Key points
Answers to questions patients ask
References
81 ICSI or IVF for nonmale‐factor infertility?
Background
Management options. ICSI vs. IVF for nonmale‐factor or unexplained infertility
ICSI vs. IVF for advanced maternal age
ICSI vs. IVF in low number/ poor quality oocyte
ICSI vs. IVF in PGT
Risks
Costs
Key points
Answers to questions patients ask
References
82 Cryostorage failure in ART
Background
Management options. Legal considerations
Precautionary measures
Prevention. Lab recommendations
Key points
Answers to questions patients ask
References
83 The ART program during a disaster
Background
Management options and priorities. Safety of personnel and patients
Maintain communication
IVF laboratory
Continuation of patient care during evacuation or clinic closure
Aftermath
Prevention
Key points
Answers to questions patients ask
References
84 Using the wrong sperm or embryos in IVF
Background
Management options. General principles
Insemination with the wrong sperm, detected before embryo transfer (case history 1)
Insemination with the wrong sperm, detected after embryo transfer (case history 2)
Insemination with the wrong sperm, detected after delivery (case history 3)
Prevention. Awareness and double witnessing
Electronic witnessing approaches
Disposable laboratory equipment
Minimizing external distractions
Learning from near misses
Key points
Answers to questions patients ask
References
85 Unexpected inability to produce a semen sample on the day of oocyte retrieval
Background
Management options
Prevention
Key points
Answers to questions patients ask
References
86 The azoospermic patient
Background
Classification of azoospermia
Pre‐testicular azoospermia (secondary hypogonadism)
Testicular azoospermia (primary hypogonadism)
Post‐testicular azoospermia
Management options
Is the patient truly azoospermic?
No SSR in pre‐testicular azoospermia
Fertility‐inducing treatment regimens in pre‐testicular azoospermia
No SSR in retrograde ejaculation
First consider surgical correction in post‐testicular obstructive azoospermia
No SSR and ICSI without prior genetic testing and counseling
Pre‐SSR patient optimization
Which SSR operative technique?
SSR must be multiple and bilateral
SSR tissue processing
No SSR unless facilities are available for cryopreservation
No repeat SSR unless a suitable period has passed to allow recovery of testis
Effect of the testicular biopsy on testosterone levels and erectile function
Future fertility in boys conceived from SSR and ICSI
Key points
Answers to questions patients ask
References
87 ART in men with Klinefelter syndrome
Background
Management options. Patient evaluation
Sperm cryopreservation in oligozoospermic KS patients
Pre‐testicular sperm retrieval patient optimization
Surgical sperm retrieval: micro‐TESE
ICSI in KS patients
Predictors of successful TESE
Practical considerations
Genetic counseling and preimplantation genetic diagnosis
Key points
Answers to questions patients ask
References
88 ART in men with 100% immotile sperm
Background
Management options. Identify and treat any causes
Obtain a second sample
Differentiate between “virtual” and “absolute” asthenozoospermia
Viable immotile sperm due to ultrastructural abnormalities of the flagellum
Assess immotile sperm viability to choose for ICSI
Testicular sperm extraction
Results of ICSI with immotile spermatozoa
Key points
Answers to questions patients ask
References
89 Request for posthumous fatherhood with perimortem surgical sperm retrieval
Background
Management options. Methods of posthumous sperm retrieval (PSR)
Vasal retrieval
Testicular sperm extraction
Orchiectomy and epididymectomy
Electroejaculation
Optimal time to harvest
Medico‐legal and ethical issues
Europe
Middle East
Asia
Australia and New Zealand
Canada
United States experience
Conclusion
Key points
Answers to questions patients ask
References
90 Retrograde ejaculation and anejaculation
Background
Pathogenesis
Management options. Patient assessment
Management of retrograde ejaculation
Management of anejaculation
Surgical sperm retrieval techniques
Key points
Answers to questions patients ask
References
91 Sperm retrieval in cancerous testes
Background
Management options
Key points
Answers to questions patients ask
References
92 Leukocytospermia and ART
Background
Management options
Prevention
Key points
Answers to questions patients ask
References
93 The infertile male patient with a genetic cause
Background
Hypothalamic‐pituitary axis defect
Spermatogenic defect
Ductal obstruction/dysfunction
Management options
Prevention
Key points
Answers to questions patients ask
References
94 Y chromosome microdeletions and ART
Background
AZFa
AZFb
AZFc
Transmission of Y deletions to ICSI offspring
Mechanism of de novo Y chromosome deletions
Evolution and genetic constitution of the human Y chromosome
Effect of Y deletions on fertility and on couples’ choices
Management options
Key points
Answers to questions patients ask
References
95 DNA fragmentation, antioxidants and ART
Background
Oxidative stress
Management options. Sperm DNA damage testing
Antioxidants
Key points
Answers to questions patients ask
References
96 Unexpected number or sex of babies after IVF
Background
Monozygotic twinning
Superfecundation
Management options
Prevention
Key points
Answers to questions patients ask
References
97 Suspected ectopic pregnancy after IVF
Background
Management options
Serum hCG levels
Ultrasound
Laparoscopy
Treatment of ectopic pregnancy
Methotrexate treatment
Surgical treatment
Pregnancy of unknown location
Prevention
Key points
Answers to questions patients ask
References
98 Cervical ectopic pregnancy after IVF
Background
Management options. Diagnosis
Treatment
Suggested protocols for treatment of cervical pregnancy
Fertility after cervical pregnancy
Key points
Answers to questions patients ask
References
99 Heterotopic pregnancy after IVF
Background
Management options. Challenges in diagnosis
Challenges in treatment. Medical treatment
Surgical treatment
Prognosis for the IUP
Prevention
Key points
Answers to questions patients ask
References
100 Multifetal pregnancy reduction after IVF
Background
Management options
When to perform MFPR
Effect of chorionicity
Technique
Reduction to a twin pregnancy
Reduction to a singleton pregnancy
Patient counseling
Prevention and legal aspects
Key points
Answers to questions patients ask
References
101 Multiple pregnancy after IVF: how to reduce preterm delivery
Background
Management options
Cervical monitoring
Cervical cerclage. Prophylactic cerclage (history indicated or based on multiple pregnancy alone)
Ultrasound‐indicated cerclage
Bed rest
Progesterone support
Prevention
Key points
Answers to questions patients ask
References
102 Hyperreactio luteinalis after IVF
Background
Management options
Key points
Answers to questions patients ask
References
103 Lactation by a commissioning mother in surrogacy
Background
Management options
Prolactin secretion‐increasing drugs
Hormones
Herbs
Nonpharmacologic methods
Key points
Answers to questions patients ask
References
104 Children of ART
Background
Management options. Neonatal outcomes after ART
Childhood development and ART
Physical health outcomes in childhood and ART
General hospital admissions
Childhood cancer
Endocrine disorders and fertility problems
Cardiovascular disease
Prevention
Key points
Answers to questions patients ask
References
105 Managing physical symptoms during IVF
Background
Management options. Down‐regulation with GnRH agonist
Possible side effects of injections
Ovarian stimulation
Post‐oocyte retrieval
Luteal support
Prevention
Key points
Answers to questions patients ask
References
106 IVF when the prognosis is very poor or futile
Background
Management options
Futile treatment
Very poor prognosis treatment
Prevention
Key points
Answers to questions patients ask
References
107 Dealing with the emotional distress following failed IVF
Background
Management options. Psychological distress after IVF failure: rates and risk factors
Helping patients cope with distress
Integrating medical and mental health care
Prevention
Key points
Answers to questions patients ask
References
108 Couple splitting while embryos are in storage
Background
Management options. Issues to consider
Legal issues
The contract approach – Kass v. Kass: pre‐freezing agreement
The contemporaneous‐mutual‐consent approach – Davis v. Davis: no pre‐freezing agreement
The balancing approach
Relationship issues
Ethical issues
Charting the way forward
Prevention
Key points
Answers to questions patients ask
References
109 Unexpected drop in the IVF clinic pregnancy rate
Background
Management options. When should troubleshooting start?
Troubleshooting in cases of poor embryo quality. Troubleshooting in the clinic
Changes in ovarian stimulation strategy or management
New staff making clinical decisions
Overstimulation
Follicle aspiration
Patient demographics
Troubleshooting in the laboratory. Poor quality culture medium
Changes in protocols or procedures
Inexperienced staff
A low staff/workload ratio
A low incubator/workload ratio
Environmental factors
Problems with power supply
Poor temperature control
Poor pH and osmolality control
Contamination with toxic materials
Microbial colonization
Development/survival assays
Troubleshooting in cases of optimal embryo quality. Troubleshooting in the clinic. New clinicians performing embryo transfer
Luteal support medication
Troubleshooting in the laboratory
Prevention
Key points
Answers to questions patients ask
References
110 Natural fertility after IVF
Background
Management options
Key points
Answers to questions patients ask
References
111 Training in ART*
Background
Management options. Participation of trainees in ART procedures
Reproductive surgery
Reproductive endocrinology versus infertility
Key points
Answers to questions patients ask
References
Notes
112 Keeping up to date in ART practice
Background
Management options. Defining the challenge and the learning strategy
Platforms and resources to stay up to date (Table 112.1) Print media and online journals
Systematic reviews and summary guidelines
Libraries and journal clubs
Networking, conferences and e‐learning
Prevention
Key points
Answers to questions patients ask
References
113 Cross‐border reproductive care
Background
Management options. Global CBRC markets
CBRC and third‐party reproduction
Patients
Doctors
Brokers
Donors and surrogates
CBRC and emerging fertility services
Prevention
Key points
Answers to questions patients ask
References
114 Satellite and transport ART treatment
Background
Management options. Satellite ART treatment
Transport ART treatment
Results
Requirements. Oocyte harvesting prior to transport
Transport
Semen samples
Transportation distance and time
Training and coordination
Key points
Answers to questions patients ask
References
115 Social media use in ART
Background
Management options. Social media: a mobile, digital bulletin board
The current state of SM in infertility care
Common platforms and their usage
Facebook
Instagram
Twitter
Audio and video platforms
Why establish an SM presence?
How to establish an SM presence?
Content creation best practices
Administration considerations
Key Points
Answers to questions clinicians ask
References
116 Managing an ART unit as a profitable business
Background
Management options. Core business components of a successful ART unit
Corporate office. Human resources department
Finance and procurement
Marketing and business development
Highly qualified and loyal healthcare professionals
Doctors
Embryologists
Brand identity
Why are equity investors so interested in ART?
Expansion
Key points
Answers to questions stakeholders commonly ask
References
Index
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d
e
f
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h
i
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m
n
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p
q
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t
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w
x
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z
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