Infertility in Practice

Cover
Half Title
Series
Title
Copyright
Dedication
Contents
Foreword
Preface
About the Author
1. Epidemiology of Infertility, 21st-Century Considerations and the Covid-19 Pandemic
1.1 Introduction
1.2 Ovarian Ageing
1.3 At What Age Should Couples Start Trying for a Family?
1.4 Fertility Education
1.5 Measuring Infertility and Response to Treatment
1.6 Definition of Infertility
1.7 Is Infertility Becoming More Common?
1.8 Is Infertility on the Rise?
1.9 Principles of Infertility Treatment
1.10 Covid-19 and Fertility
2. Prevention of Infertility
2.1 Introduction
2.2 Impact of Age on Male and Female Fertility
2.3 Can Women Protect Fertility against Ageing?
2.4 Contraception
2.5 Environmental Pollutants
2.6 Are Sperm Counts Falling?
2.7 Hypospadias, Cryptorchidism and Testicular Cancer
2.8 Conclusion
3. Planning a Pregnancy and Preconception Care
3.1 Introduction
3.2 A Preconception Healthcare Programme
3.3 Body Weight
3.4 Dietary Advice for Women Wishing to Conceive
3.5 Folic Acid (Folate)
3.6 Exercise
3.7 Supplements for Male Fertility
3.8 Special Diets for Sex Selection
3.9 The Microbiome
3.10 Oral Health
3.11 Smoking, Alcohol and Recreational Drugs
3.12 Anabolic Androgenic Steroids
3.13 Acquired Infections
3.14 Medical Conditions and Drugs
3.15 Endocrine Disorders
3.16 Diabetes
3.17 Psychiatric Disorders
3.18 Neurological Disorders
3.19 Gastrointestinal Disease
3.20 Renal Disease
3.21 Cardiovascular Disease
3.22 Respiratory Disease
3.23 Antibiotics and Anti-Infective Agents
3.24 Haematological Problems
3.25 Connective Tissue Disorders
3.26 Chemotherapy
4. Obesity and Reproduction
4.1 Introduction
4.2 Defining Obesity and the Extent of the Problem
4.3 Influence of Obesity on Natural Fertility
4.4 Obesity and Polycystic Ovary Syndrome
4.5 Effect of Obesity on Treatment of Anovulatory Infertility
4.6 Effect of Obesity on IVF and Related Treatments
4.7 Effect of Obesity on Pregnancy
4.8 Provision of Support in Achieving Weight Loss
4.9 Guidelines for Accessing Treatment
5 Investigating Infertility
5.1 Introduction
5.2 General Investigations
5.3 Investigating the Female Partner
5.4 Diagnosis of Anovulatory Infertility
5.5 Endocrine Profile
5.6 Progesterone
5.7 Follicle-Stimulating Hormone
5.8 Ovarian Reserve Tests
5.9 Luteinising Hormone
5.10 Androgens
5.11 Thyroid Function
5.12 Prolactin
5.13 Oestrogen
5.14 Glucose Tolerance
5.15 Other Investigations
5.16 Pelvic Ultrasound
5.17 Ovarian Morphology
5.18 Differentiating between PCOM and PCOS
5.19 Ovarian Cysts
5.20 Endometrial Assessment
5.21 Doppler Ultrasound in Assisted Conception
5.22 Assessment of Tubal Patency and the Uterine Cavity
5.23 Ultrasound Contrast Hysterosalpingography or Hysterosalpingo Contrast Sonography
5.24 Selective Salpingography and Falloposcopy
5.25 Laparoscopy and Hysteroscopy
5.26 Transvaginal Hydroculdoscopy/Hydrolaparoscopy/Salpingoscopy
5.27 Choosing between HSG and Laparoscopy
5.28 MRI/Computed Tomography Scans
5.29 Investigating the Male Partner
5.30 Semen Analysis
5.31 Reduced Sperm Concentration (Oligozoospermia)
5.32 Impaired Sperm Morphology (Teratozoospermia)
5.33 Reduced Sperm Motility (Asthenozoospermia)
5.34 Sperm Dysfunction and DNA Fragmentation
5.35 Leukospermia
5.36 Cervical Mucus Penetration and the Post-Coital Test
5.37 Antisperm Antibodies
5.38 Serum Endocrinology in the Male
5.39 Chromosomal Analysis
5.40 Imaging in Male Infertility
5.41 Testicular Exploration and Biopsy
6. Anovulatory Infertility and Ovulation Induction
6.1 Introduction
6.2 Primary and Secondary Amenorrhoea
6.3 Pituitary and Hypothalamic Causes of Anovulation
6.4 Hypogonadotrophic Hypogonadism
6.5 Weight-Related Amenorrhoea
6.6 Systemic Disorders Leading to Anovulation
6.7 Exercise-Related Amenorrhoea
6.8 Hyperprolactinaemia
6.9 Polycystic Ovary Syndrome
6.10 Summary
7. Polycystic Ovary Syndrome
7.1 Introduction
7.2 What Is PCOS?
7.3 Pathophysiology of PCOS
7.4 Ovarian Biochemistry
7.5 Hypothalamic-Pituitary-Ovarian Axis
7.6 Hyperinsulinaemia
7.7 Definitions and Heterogeneity of PCOS
7.8 Prevalence of PCOS and Ethnic Variations
7.9 PCOS in Adolescence
7.10 Management of Non-Fertility Aspects of PCOS
7.11 Psychological Support and Quality of Life
7.12 Obesity
7.13 Menstrual Irregularity
7.14 Hyperandrogenism and Hirsutism
7.15 Reproductive Health in PCOS
7.16 Health Consequences of PCOS
7.17 PCOS and Cancer
7.18 Conclusion
8. Premature Ovarian Insufficiency and Oocyte Donation
8.1 Introduction
8.2 Control of Ovarian Ageing
8.3 Incipient POI (“Resistant Ovary Syndrome”)
8.4 Diagnosis of POI
8.5 Causes of POI
8.6 Management of POI
8.7 Oocyte Donation
8.8 Experimental Approaches to Combatting POI
9. Endometriosis
9.1 Introduction
9.2 Diagnosis
9.3 Non-Invasive Testing for Biomarkers of Endometriosis
9.4 Classification of Endometriosis
9.5 Biopsy
9.6 Cysts
9.7 Management of Endometriosis
9.8 Medical Therapy for Fertility
9.9 Surgical Therapy
9.10 Endometriosis and IVF
9.11 Adenomyosis
9.12 Proposed Strategy for Management of Endometriosis
10. Tubal Infertility, Fibroids and Uterine Factors
10.1 Introduction
10.2 Uterine Problems: Congenital Anomalies, Septa, Fibroids, Polyps, Adhesions and Uterine Anomalies
11. Male Factor Infertility
11.1 Introduction
11.2 General Lifestyle Factors
11.3 Drugs
11.4 Chemotherapy and Radiotherapy
11.5 Occupational Factors
11.6 Anabolic Steroids
11.7 Cannabis and Other Recreational Drugs
11.8 Hypospadias, Cryptorchidism and Testicular Cancer
11.9 Orchitis and Prophylactic Mumps, Measles, Rubella Vaccination
11.10 Sexually Transmitted Infections
11.11 Testicular Trauma
11.12 Hypogonadism
11.13 Oligoasthenozoospermia
11.14 Frequency of Intercourse
11.15 Leukospermia
11.16 Oxidative Stress and ROS
11.17 Varicocele
11.18 Antisperm Antibodies
11.19 Obstructive Azoospermia
11.20 Congenital Bilateral Absence of the Vasa Deferentia
11.21 Young’s Syndrome
11.22 Kartagener’s Syndrome
11.23 Surgical Trauma and Vasectomy
11.24 Microsurgical Reconstruction of the Vasa
11.25 Idiopathic Male Factor Infertility
11.26 Paternal Ageing
11.27 Coital Dysfunction and Psychosexual Problems
11.28 Hypergonadotrophic Testicular Failure
11.29 IUI, IVF and ICSI
11.30 Androgen Insensitivity Syndrome
11.31 Donor Insemination
12. Unexplained Infertility
12.1 Introduction
12.2 Assessing the Cause of Infertility
12.3 Management of Unexplained Infertility
12.4 Clomifene Citrate
12.5 Letrozole
12.6 IUI
12.7 Gamete Intrafallopian Transfer
12.8 IVF
12.9 Strategy for Management of Unexplained Infertility
13. In Vitro Fertilisation
13.1 Introduction
13.2 Indications for IVF
13.3 Viral Screening before Assisted Conception Therapies
13.4 IVF
13.5 Regimens for IVF
13.6 Dosing of Stimulation for IVF
13.7 Monitoring the IVF Cycle and Ovarian Response to Stimulation
13.8 Ovarian Reserve and Prediction of Response to Stimulation
13.9 Poor Responders
13.10 Response of the Polycystic Ovary to Stimulation for IVF
13.11 Oocyte Retrieval
13.12 Embryo Culture and Embryo Transfer
13.13 Number of Embryos for Transfer
13.14 ICSI for Severe Male Factor Infertility
13.15 The Embryo Transfer Procedure
13.16 Endometrial Assessment
13.17 The Endometrial Scratch
13.18 Luteal-Phase Support after IVF
13.19 The Frozen Embryo Replacement Cycle
13.20 Pregnancy Rates after IVF
13.21 Oocyte Donation
13.22 Surrogacy
13.23 The Human Fertilisation and Embryology Authority and Regulation in the United Kingdom
14. Fertility Preservation
14.1 Cryopreservation of Gametes and Embryos
14.2 In Vitro Growth of Follicles
14.3 Protection of the Ovaries against Chemotherapy
14.4 Testicular Tissue Freezing
14.5 Transgender Fertility Preservation
15. Pre-Implantation Genetic Testing and Emerging Technologies
15.1 Pre-Implantation Genetic Testing
15.2 Modes of Inheritance
15.3 The Process of PGT
15.4 PGT-A
15.5 Supernatant Testing
15.6 Emerging Technologies
16. Complications of Ovarian Stimulation
16.1 Introduction
16.2 Drug-Specific Side Effects
16.3 The Ovarian Hyperstimulation Syndrome
16.4 Multiple Pregnancy
16.5 The Risk of Cancers in Subfertile Populations and after Fertility Treatment
17. Counselling and Modern Families
17.1 Introduction
17.2 Infertility and Subfertility
17.3 Psychosexual Problems
17.4 How to Deal with Work
17.5 Special Needs of the Male Partner
17.6 Adjustment to Parenthood
17.7 How to Tell Children of Donated Gametes
17.8 Surrogacy
17.9 Modern Families
17.10 Transgender Pregnancies
17.11 Emotional Support for Clinic Staff
17.12 The Infertility Counsellor
17.13 Welfare of the Child
18. Ethical and Religious Issues
18.1 Introduction
18.2 Does Everyone Have a Right to Treatment?
18.3 Biological Considerations
18.4 Moral Status of the Embryo
18.5 Is IVF Ethical?
18.6 Experiments on Human Embryos, Cloning and Stem Cell Research
18.7 Donors and Donation
18.8 Sex Selection
18.9 Fetal Reduction
18.10 Should Older Women Be Offered IVF?
18.11 Religious Perspectives
18.12 Conclusion
19. Health Outcomes of Children Born after Assisted Conception
19.1 Introduction
19.2 Manipulated Gametes
19.3 IVF
19.4 ICSI
19.5 Imprinting Disorders
19.6 Cryopreserved Gametes or Embryos
20. Miscarriage and Ectopic Pregnancy
20.1 Introduction
20.2 Incidence of Miscarriage
20.3 Parental Age
20.4 Health Conditions, Lifestyle Factors and Risks of Miscarriage
20.5 Diagnosis of Pregnancy
20.6 Prevention of Miscarriage
20.7 Management of Miscarriage
20.8 Ectopic Pregnancy
20.9 Diagnosis of Ectopic Pregnancy
20.10 Management of Ectopic Pregnancy
20.11 Counselling and Support
21. Recurrent Miscarriage and Recurrent Implantation Failure
21.1 Introduction
21.2 Classification of Recurrent Miscarriage
21.3 Nutritional Causes
21.4 Environmental Factors
21.5 Genetic Causes
21.6 Anatomical Abnormalities
21.7 Infection and the Microbiome
21.8 Endocrine Abnormalities
21.9 Luteal-Phase Defects and Progesterone Therapy
21.10 Thrombophilias
21.11 Immunological Causes of Recurrent Miscarriage
21.12 Summary of the Investigation and Management of Couples with Recurrent Miscarriage
21.13 Recurrent Implantation Failure
22. Alternative Therapies and “Add-Ons”
23. When to Stop Treatment and Other Options
23.1 Introduction
23.2 Adoption
23.3 Adopting a Child from Overseas
23.4 Fostering
23.5 Respite Care
Appendix: Daily Vitamin and Mineral Requirements (See Chapter 3)
Books for Further Reading
Index