Practical Problems in Assisted Conception

Practical Problems in Assisted Conception......Page 1
Half Title......Page 3
Title Page......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Chapter 1 A Lifetime Observations and Reflections as an IVF Doctor......Page 13
References......Page 16
Chapter 2 The Patient Perspective of Assisted Reproduction......Page 17
Data from Published Systematic Reviews......Page 19
Significance of Size of Fibroids......Page 20
Conclusions and a Practical Approach to Management in Clinical Practice......Page 21
References......Page 22
Which Follicle-Stimulating Hormone to Use......Page 23
What Dosage to Give......Page 24
References......Page 25
Predictive Tests of Poor Response......Page 26
Stimulation Protocols Used in Poor Responders......Page 27
Adjuvant Therapies for Poor Responder Patients......Page 28
Counseling......Page 29
References......Page 30
Background......Page 31
Considerations for Patient Selection......Page 32
Assessment of Risk to Fertility (Table 6.2)......Page 33
Suggested Documentation......Page 34
References......Page 35
Gonadotropin Hormone-Releasing Hormone Agonists......Page 36
Cryopreservation of Unfertilized or Fertilized Oocytes......Page 37
References......Page 38
Diagnosis......Page 40
Surgical Treatment......Page 41
Suggested Audits......Page 42
References......Page 43
Sperm Quality in Older Men......Page 44
Risks to Child Health and Development......Page 45
Suggested Standard Operating Protocol (SOP)......Page 46
References......Page 47
Discussion on Endometrioma-Specific Treatment Options......Page 48
Discussion on Stimulation Protocols and Treatment-Adverse Effects......Page 49
Further Reading......Page 50
References......Page 51
Ultrasound......Page 52
Treatment Hysteroscopic Surgery......Page 53
Foley Catheter......Page 54
Antibiotics......Page 55
References......Page 56
In Vitro Research: Biologically Plausible Mechanisms......Page 58
In Vivo Research: Clinical Trials on Acupuncture and CHM Acupuncture......Page 59
CAM Interventions during IVF......Page 60
References......Page 61
How Does the 揚roblem? Relate to IVF and Vice Versa?......Page 63
Strategies/Solutions......Page 64
References......Page 65
The Patient Who Has a Uterine Abnormality Diagnosed at Tubal Assessment......Page 67
Methods of Tubal Assessment Hysterosalpingography (HSG)......Page 68
Laparoscopy and Dye......Page 70
Fertiloscopy or Transvaginal Hydrolaparoscopy......Page 71
Chlamydia Testing......Page 72
Suggested Audit......Page 73
References......Page 74
Which One Is Better? Single Step or Sequential?......Page 75
Embryo Manipulation and Culture Approaches......Page 76
References......Page 77
How to Set Up and Manage Key Performance Indicators (KPI)......Page 78
Processes......Page 82
Laboratory Equipment......Page 83
Conclusion......Page 84
References......Page 85
Clinical Significance of EMT and Endometrial Pattern Clinical Significance of EMT......Page 86
Clinical Significance of Endometrial Pattern......Page 87
Managing Thin Endometrium in IVF......Page 88
Therapies to Improve Endometrial Perfusion......Page 89
References......Page 90
Pathophysiology......Page 91
Management......Page 93
References......Page 95
Progesterone Preparations and Routes of Administration and Duration of Luteal Support......Page 98
Protocols......Page 101
References......Page 102
Controlled Ovarian Stimulation: Protocols and Regime......Page 104
Pharmacologic Interventions......Page 106
References......Page 107
Cause of Subfertility......Page 109
Anesthetic Management......Page 110
References......Page 112
Preliminary Steps......Page 114
Movement of Aspiration Needle......Page 115
Follicle/Blood Vessel......Page 116
References......Page 117
The Setup......Page 119
Issues Relating to Machine/System Setup......Page 120
Reference......Page 121
Adequate Follicular Recruitment and Development......Page 122
Reduced Human Chorionic Gonadotrophin or Luteinizing Hormone/Progesterone Bioavailability......Page 123
Suggested Audit......Page 124
References......Page 125
Technique for Egg Collection......Page 126
Early Complications......Page 127
References......Page 129
Cervical Mucus and Blood......Page 130
Bladder Filling......Page 131
Cervical Dilatation......Page 132
Avoiding a Difficult Embryo Transfer......Page 133
References......Page 134
Normal Erectile Function and Ejaculation......Page 135
Conservative Measures......Page 136
Surgical Sperm Recovery (SSR)......Page 137
References......Page 138
Identification......Page 139
Identification......Page 140
Identification......Page 141
Resolution......Page 142
References......Page 143
Operator and Protocol......Page 144
Human Factors......Page 145
Patient Demographics......Page 146
Corrective Actions and Preventative Measures......Page 147
Reference......Page 149
Moving Oocytes and Embryos between Dishes......Page 150
Conclusion......Page 153
Acknowledgements......Page 154
Sources of Infection......Page 155
Identification......Page 156
Prevention......Page 157
References......Page 159
Polar Body Biopsy......Page 160
Platform for Couples with Genetic Disorders......Page 161
Mosaicism......Page 162
Should PGD Always Be Coupled with PGS?......Page 163
References......Page 164
Endometrium and Sub-Endometrium......Page 165
Congenital Anomalies......Page 166
Patency......Page 167
Follicle Tracking......Page 168
Conclusion......Page 169
References......Page 170
Lifestyle Changes......Page 171
Improving Embryo Quality and Selection......Page 172
Intra-Cavity Lesion......Page 173
Clinical Trials......Page 174
References......Page 175
What Is Fertilization Failure?......Page 177
Optimizing the Laboratory Environment......Page 178
Conclusion......Page 179
References......Page 180
What Is Poor Embryo Development?......Page 181
Oocytes: Cause of Aneuploidy and Influence on Embryo Development......Page 182
Laboratory: In Vitro Culture and Reprotoxicity......Page 183
Will Poor-Quality Embryos in One Cycle Mean Poor-Quality Embryos in the Subsequent Cycles?......Page 184
References......Page 185
What Is a Quality Management System and Why Have It?......Page 186
The Crucial Elements of the QMS Personnel......Page 187
Document Control......Page 188
Validation......Page 190
Conclusion......Page 191
References......Page 192
Human Performance Is Variable......Page 193
Teamwork......Page 194
Checks and Checklists......Page 195
References......Page 196
Suggestions for Further Reading......Page 197
Positioning and Branding......Page 198
How Are We Going to Get There? Develop a Marketing Plan......Page 199
References......Page 202
Study Setup......Page 203
Data Collection......Page 204
The Referral Process......Page 205
Summary......Page 207
References......Page 208
How to Get Information to Develop a Business Plan......Page 209
Understanding a Business Plan for an IVF Unit Setup......Page 210
Understanding the Business Economics: Profit and Loss Statement......Page 211
Revenue and Costs for an IVF/ Infertility Clinic Revenue from Services......Page 213
Cost of Running an Infertility Center......Page 214
Introduction to a Balance Sheet......Page 215
Which Measure to Use While Setting Up a Business......Page 216
Operational/Strategic Choices (Options) while Setting Up an IVF Business......Page 217
For Further Reading......Page 218
Chapter 42 The Essentials for Building a Great Fertility Team Take Five with Fiona Pringle......Page 219
ART 3.0......Page 221
References......Page 223
Conversation Questions......Page 224
Index......Page 227