Clinical In Vitro Fertilization

1 Selection and Preparation of Patients for In Vitro Fertilization.- 1.1 Introduction.- 1.2 The Waiting List.- 1.2.1 Patient Activation.- 1.3 Length of Menstrual Cycles — Confidence Limits.- 1.4 Hormonal Assessment.- 1.5 Assessment of Semen.- 1.5.1 Provision of Semen.- 1.5.2 Preliminary Sperm-wash Preparation.- 1.5.3 Immunological Studies.- 1.5.4 Microbiological Assessment of Semen.- 1.6 Serological Assessment.- 1.6.1 Female Partner.- 1.6.2 Male Partner.- 1.7 Bacteriological Assessment of the Cervix.- 1.8 Assessment of the Pelvis Prior to Treatment.- 1.9 Consent Forms.- 1.10 Psychological Preparation.- 1.11 Patient Support Group.- 2 Patient Management.- 2.1 Introduction.- 2.2 Natural Folliculogenesis.- 2.2.1 Luteinization and Ovulation.- 2.3 Stimulated Follicular Development.- 2.3.1 Hyperstimulation.- 2.3.2 Inadequate Stimulation.- 2.3.3 GnRH Agonists.- 2.4 Conclusion.- 3 Oocyte Pick-up.- 3.1 Introduction.- 3.2 Laparoscopic Method.- 3.3 Ultrasound-Guided Techniques.- 3.3.1 Transvesical Approach.- 3.3.2 Perurethral Approach.- 3.3.3 Transvaginal Approach.- 3.4 Ultrasound-Guided Technique Using a Combined Vaginal Needle and Transducer.- 3.4.1 Machines.- 3.4.2 Aspiration Needles.- 3.4.3 Sterilization of Transducers.- 3.4.4 Vaginal Preparation.- 3.4.5 Anaesthesia.- 3.4.6 Technique.- 3.4.7 Difficulties with Technique.- 3.5 Results.- 3.6 Conclusions.- 4 Fertilization and Embryo Culture.- 4.1 Introduction.- 4.2 Quality Control of Laboratory Procedures.- 4.2.1 Incubators.- 4.2.2 Glassware and Other Equipment.- 4.2.3 Water.- 4.2.4 Other Factors.- 4.2.5 Toxicity.- 4.3 Media for Insemination of Eggs and Culture of Embryos.- 4.3.1 Complex Media.- 4.3.2 Simple Balanced Salt Solutions.- 4.3.3 Serum Supplementation.- 4.3.4 Physiological Fluids.- 4.3.5 Choice of Culture Medium.- 4.4 Culture Conditions and Methods.- 4.5 Evaluation of Eggs.- 4.6 Insemination of Eggs.- 4.7 Microfertilization Techniques.- 4.8 Evaluation of the Fertilization Process.- 4.9 Evaluation of Embryos.- 4.10 Conclusions.- 5 Results from In Vitro Fertilization.- 5.1 The Evaluation of Results H. W. Jones Jr.- 5.1.1 Numerator Problems.- 5.1.2 Denominator Problems.- 5.2 Results P. A. W. Rogers.- 5.2.1 Ovulation Induction and Oocyte Retrieval.- 5.2.2 Fertilization and Embryo Transfer.- 5.2.3 Pregnancy.- 5.2.4 Gamete Intra-fallopian Transfer.- 5.2.5 Embryo Cryopreservation.- 6 Gamete Intra-fallopian Transfe.- 6.1 History.- 6.2 Gamete Preparation.- 6.2.1 Ovarian Stimulation and Laparoscopic Follicle Aspiration.- 6.2.2 Preparation of Spermatozoa.- 6.3 Gamete Transfer.- 6.3.1 Laparoscopy.- 6.3.2 Minilaparotomy.- 6.3.3 Transvaginal GIFT.- 6.4 Results.- 6.4.1 Pregnancies and Pregnancy Outcomes.- 6.4.2 Effect of Technical Factors.- 6.4.3 Effect of Oocyte Number.- 6.4.4 Effect of Clinical Variables.- 6.5 Complications.- 7 Outcome of Pregnancy.- 7.1 Introduction.- 7.2 Characteristics of Infertile Couples.- 7.3 Overall Results of IVF Pregnancies.- 7.4 Early Pregnancy Losses.- 7.4.1 Preclinical Abortion.- 7.4.2 Spontaneous Abortion.- 7.4.3 Ectopic Pregnancy.- 7.5 Viable Pregnancies.- 7.5.1 Duration of Pregnancy.- 7.5.2 Multiple Pregnancy.- 7.5.3 Obstetric Complications.- 7.5.4 Mode of Delivery.- 7.6 Infants Born after In Vitro Fertilization.- 7.6.1 Sex Ratio.- 7.6.2 Birthweight.- 7.6.3 Fetal Growth.- 7.6.4 Perinatal Mortality.- 7.6.5 Congenital Malformations.- 7.6.6 Follow-up Studies.- 7.7 Conclusions.- 8 Andrology, Male Factor Infertility and IVF.- 8.1 Introduction.- 8.2 Assessment of the Male.- 8.2.1 Semen Analysis.- 8.2.2 Advanced Semen Analysis.- 8.3 Separation of Motile Sperm.- 8.3.1 “Swim-up” Procedure.- 8.3.2 Albumin Columns.- 8.3.3 Glass Wool Columns.- 8.3.4 Sedimentation.- 8.3.5 Percoll Gradients.- 8.4 Male Factor Infertility.- 8.4.1 IVF and Male Factor Infertility.- 9 Oocyte Freezing.- 9.1 Introduction.- 9.2 The Human Oocyte.- 9.2.1 Oocyte Meiosis and Maturation.- 9.3 Feasibility of Oocyte Cryopreservation.- 9.3.1 Animal Evidence.- 9.3.2 Human Studies.- 9.4 Cryobiological Concepts in Oocyte Cryopreservation.- 9.4.1 Cryobiological Concepts.- 9.4.2 Cellular Events During Freezing and Thawing.- 9.5 Developing Oocyte Freezing Using an Animal Model.- 9.6 Establishing Human Oocyte Freezing.- 9.7 Factors Influencing Successful Freezing.- 9.7.1 Criteria for Oocyte Selection.- 9.7.2 Stage of Oocyte Maturation.- 9.7.3 Size of Oocyte-Cumulus Oophorus Complex.- 9.7.4 Volume of Medium for Freezing.- 9.7.5 Exposure to DMSO.- 9.7.6 Seeding.- 9.7.7 Rate of Freezing.- 9.7.8 Rate of Thawing.- 9.7.9 Assessment of the Oocyte.- 9.8 Results of Human Oocyte Cryopreservation.- 9.8.1 Clinical Studies.- 9.9 Discussion.- 9.9.1 Practical Applications of Human Oocyte Cryopreservation.- 9.9.2 Advantages of Human Oocyte Cryopreservation.- 9.9.3 Frozen Human Oocyte Pregnancies World-wide.- 10 Embryo Cryopreservation.- 10.1 Introduction.- 10.2 Requirements for Embryo Freezing.- 10.3 Development of Slow Cooling Methods for Cryopreserving Human Embryos.- 10.4 Methods of Cryopreservation by Slow Cooling.- 10.4.1 Slow Cooling in DMSO.- 10.4.2 Slow Cooling in 1,2-Propanediol.- 10.4.3 Slow Cooling in Glycerol.- 10.5 Success of Cryopreservation by Slow Cooling.- 10.6 The Development of Rapid Cooling Methods for Cryopreservation.- 10.6.1 Vitrification.- 10.6.2 Vapour Freezing.- 10.6.3 Ultrarapid Freezing.- 10.7 Use of Rapid Freezing Methods for Cryopreservation of Human Embryos.- 10.8 Cryopreservation of Embryos and Unfertilized Oocytes.- 10.9 Conclusion.- 11 Oocyte Donation.- 11.1 Introduction.- 11.2 Indications for Donor Oocytes.- 11.3 Clinical Management.- 11.3.1 Counselling.- 11.3.2 Synchronization.- 11.3.3 Embryo Transfer.- 11.4 Source of Donor Oocytes.- 11.4.1 IVF Patients.- 11.4.2 Known Donors.- 11.4.3 Volunteer Donors.- 11.4.4 Women Undergoing Sterilization.- 11.4.5 Donation of Oocytes Fertilized In Vivo.- 11.5 Steroid Replacement Therapy.- 11.6 Uterine Receptivity for Implantation.- 11.7 Endocrinology of Pregnancy.- 11.7.1 Luteo-placental Shift.- 11.7.2 Inhibin.- 11.7.3 Delivery.- 11.8 Legal Aspects.- 12 Infertility Counselling.- 12.1 Introduction.- 12.2 Why Would Anyone Seek or Need Specialised Infertility Counselling.- 12.3 Is Counselling Synonymous with “Assessment”.- 12.4 Who Does the Counselling.- 12.5 What Are Common Expressions Indicating Consideration of a Counselling Referral.- 12.6 When is Infertility Counselling Appropriate.- 12.6.1 Initial Diagnosis of Infertility.- 12.6.2 Waiting List.- 12.6.3 First Treatment Cycle.- 12.6.4 Pregnancy Test.- 12.6.5 Timing of Next Attempt.- 12.6.6 Deciding to Finish IVF Treatment.- 12.7 Should Counselling Be Compulsory for All Couples Seeking IVF.- 12.8 Are There Particular Treatment Options Necessitating Prior Counselling.- 12.9 What Are the Particular Issues a Counsellor Would Discuss with Couples Contemplating the Use of Donor Gametes.- 12.10 What is the Counselling Role of Support Groups.