Clinical In Vitro Fertilization

Man is entering a new era as a result of advances in human reproduction. Techniques have been developed to assist in the creation of man-artificial insemination and, now, in vitro fertilization (IVF). Soon, other new methods, based upon current advances of the IVF procedure, will develop to improve the quality of human reproduction. The book describes the conceptual framework and details of technique concerned with in vitro fertilization and embryo transfer (ET). Edwards and Steptoe first described the technique of IVF and ET and the subsequent births of two normal babies. Since then, the success rate of the system has been improved by the use of fertility drugs to provide more oocytes and preincubation to mature the oocyte before fertilization. As a result of the continued research from Melbourne and Cambridge, more than 100 babies have been born. A free interchange of information between the Cambridge and Melbourne groups has led to a predictable success rate of 15%-20% per laparoscopy, and infertility centres all over the world are now copying the techniques. It is an appropriate time to inform doctors and scientists to help them understand the various procedures involved in IVF and ET. While many advances will occur in the future, the establishment of high success rates in several of the critical steps in the procedure-oocyte pick-up rate (90%), fertilization (>90%) and early embryo development (70%-90% )-signifies that some of the new techniques are stabilized sufficiently to warrant transmission of information by text, rather than scientific journal.

1 History.- 1.1 Introduction.- 1.2 Embryo Transfer.- 1.3 Embryo Culture.- 1.4 Fertilization In Vitro.- 1.5 The Historical Development of Knowledge Conceming Ova, Sperm and Embryo.- 1.6 Development of In Vitro Fertilization and Embryo Transfer in Humans.- 2 Current Status and Future Prospects.- 2.1 Current Status.- 2.2 Future Prospects.- 3 Selection of Patients.- 3.1 Introduction.- 3.2 Tubal Disease.- 3.3 Idiopathic Infertility.- 3.4 Endometriosis.- 3.5 Male Infertility.- 3.6 Ovarian Disease.- 3.7 Absence or Disease of Uterus.- 3.8 Absence of Uterus and Ovaries.- 3.9 General Health in Selection of Patients.- 4 Patient Management and Preparation for In Vitro Fertilization.- 4.1 Waiting List.- 4.2 Accessibility of Ovaries.- 4.3 Length of Previous Menstrual Cycles.- 4.4 Endocrine Assessment.- 4.5 Assessment of the Semen for Fertility.- 4.6 Serological Assessment of the Female Partner.- 4.7 The Consent Form.- 4.8 Special In Vitro Fertilization Clinics.- 4.9 Psychological Preparation.- 4.10 Patient Support Group.- 5 Patient Management Treatment Cycle.- 5.1 Patient Accession.- 5.2 The Ovulatory Cycle.- 5.3 Stimulated Follicular Development.- 5.4 Criteria for Administration of hCG.- 5.5 Ovarian Hyperstimulation.- 5.6 Results of Ovarian Stimulation Regimes (1981).- 6 Oocyte Pick-up.- 6.1 Timing.- 6.2 Laparoscopy Technique.- 6.3 Instrumentation.- 6.4 Collecting Technique.- 6.5 Difficulties in Oocyte Collection.- 6.6 Results.- 6.7 Conclusion.- 7 Assessment and Preparation of Semen for In Vitro Fertilization.- 7.1 Assessment of the Male.- 7.2 Preparation of Semen.- 7.3 Future Possibilities.- 8 In Vitro Fertilization and Embryo Growth.- 8.1 Introduction.- 8.2 Oocyte Maturation.- 8.3 In Vitro Fertilization.- 8.4 Embryo Growth.- 9 Embryo Transfer.- 9.1 The Physiological Process ofNatural Embryo Transfer.- 9.2 Quality of Embryo.- 9.3 Age of Embryo.- 9.4 Number of Embryos Transferred.- 9.5 Route of Transfer.- 9.6 Technique of Embryo Transfer.- 9.7 Difficulties Encountered with Embryo Transfer.- 9.8 Postembryo Transfer Care.- 9.9 Ethical Problems Related to Embryo Transfer.- 9.10 Results.- 9.11 Summary.- 10 Biological Risks of In Vitro Fertilization and Embryo Transfer.- 10.1 Congenital Abnormalities and Malformations.- 10.2 Complications During In Vitro Culture.- 10.3 Complications After Embryo Transfer.- 11 Pregnancy Care.- 11.1 General Obstetric Care.- 11.2 Psychological Support.- 11.3 First Trimester.- 11.4 Second Trimester.- 11.5 Third Trimester.- 11.6 Parturition.- 11.7 The Puerperium.- 11.8 Long-term Follow-up.- 11.9 Perinatal Mortality.- 11.10 Birth Weights.- 11.11 Sex Ratio at Birth.- 11.12 Congenital Malformation.- 11.13 Preterm Labour.- 12 Summary of Results.- 12.1 Introduction.- 12.2 Follicular Aspiration.- 12.3 In Vitro Fertilization.- 12.4 Embryo Transfer.- 12.5 Pregnancies.- 13 The Establishment of an In Vitro Fertilization Programme.- 13.1 Introduction.- 13.2 Where Should an In Vitro Fertilization and Embryo Transfer Programme Be Developed?.- 13.3 Personnel Required for Setting Up In Vitro Fertilization and Embryo Transfer.- 13.4 Equipment.- 13.5 Cost of In Vitro Fertilization and Embryo Transfer.- 14 Ethics.- 14.1 Introduction.- 14.2 Moral Issues.- 14.3 Theological Difference.- 14.4 Medical Ethics.- 14.5 Situational Ethics A Pragmatic Approach.- 14.6 Specific Ethical Problems Questions and Answers.- Appendix. The Couples Guide to In Vitro Fertilization Treatment.- 1 Introduction.- 2 Health Preparation.- 3 Preparation for In Vitro Fertilization Treatment Tests.- 4 Treatment Cycle Tests.- 5 In Hospital.- 6 Ovulation andLaparoscopy.- 7 Time To Go Home.- 8 Answers to Questions Commonly Asked About In Vitro Fertilization Treatment.- 9 Decisions, Decisions.- 10 Pregnancy Following In Vitro Fertilization.