Cover

Half-title

Title

Copyright

Dedication

Contents

Preface

Foreword

Acknowledgements

Introduction

1 The male reproductive system

Introduction

The male sex organs

Production of spermatozoa

Development of the testis

Hormones that control the function of the adult male sex organs

Erection and ejaculation

Composition of semen

Semen parameters

Applied concepts

BIBLIOGRAPHY

2 The female reproductive system

Introduction

The female sex organs

Development of the ovary

Ovarian cycle

Hormonal control of the ovarian cycle

Menstrual cycle

The 'phases'

Cycle length and timing of events

Cervical mucus

Applied concepts

BIBLIOGRAPHY

3 Fertilization, implantation and early development

Introduction

Transport of spermatozoa in the female

The mature oocyte

Fertilization

Transport of the embryo, hatching and implantation

BIBLIOGRAPHY

4 Male factor problems

Introduction

Sexual and/or ejaculatory dysfunction

Infrequent sexual intercourse

Wrong timing of sexual intercourse

Impotence or ejaculatory failure

Premature ejaculation

Retrograde ejaculation

Extravaginal ejaculation

Immunological cause

No demonstrable abnormality

Isolated seminal plasma abnormalities

Iatrogenic cause

Systemic cause

Congenital abnormalities

Acquired testicular damage

Varicocoele

Male accessory gland infection

Endocrine cause

Unexplained poor semen parameters

Obstructive azoospermia

Conclusion

BIBLIOGRAPHY

5 Female factor problems

Introduction

The vagina

The cervix

The uterus

Fibroids

Endometritis

Asherman's syndrome

Uterine malformations

The fallopian tubes

The ovaries

Hypogonadotrophic hypogonadism

Ovarian failure

Polycystic ovary syndrome

Weight loss

Strenuous exercise

Hyperprolactinaemia

Endometriosis

No detectable problem

Conclusion

BIBLIOGRAPHY

6 Evaluation of the infertile couple

Introduction

Preliminary information from the couple

Evaluation of the female partner

Clinical history

Physical examination

Routine investigations

Tests for ovulation

Basal body temperature (BBT) monitoring

Cervical mucus

Endometrial biopsy

Ultrasonog aphy of the ovaries and endometrium

Day 21 progesterone assay

Luteinizing hormone surge detection

Other hormone tests

Tubal patency tests

Rubin's test

Hysterosalpingogram (HSG)

HyCoSy

Laparoscopy and dye test

Cervical mucus tests

Optional investigations

Pelvic ultrasound scan

Hysteroscopy

Other tests not related to the causes of infertility

Additional investigations

Female diagnosis

Evaluation of the male partner

Clinical history

Physical examination

Investigations: semen analysis

Additional investigations

Other tests

The male diagnosis

Conclusion

BIBLIOGRAPHY

7 Medical and surgical treatment of infertility

Introduction

Treatment of the male partner

Impotence

Retrograde ejaculation

Anejaculation

Antisperm antibodies in the man

Hypogonadotrophic hypogonadism

Hyperprolactinaemia

Accessory gland infection

Varicocoele

Obstructive azoospermia

Azoospermia not due to obstruction

Other considerations

Treatment of the female partner

Exercise and weight loss induced ovulatory dysfunction

Hypogonadotrophic hypogonadism

Polycystic ovary syndrome

Clomiphene citrate

GnRH

Gonadotrophins

Ovarian diathermy

Hyperprolactinaemia

Medical treatment

Surgical treatment

Radiation treatment

Ovarian failure/resistant ovary syndrome

Antisperm antibodies in the female

Vaginismus

Endometriosis

Tubal problems

Conclusion

BIBLIOGRAPHY

8 Conventional in vitro fertilization treatment

Introduction

Patient selection for conventional IVF and related treatments

Manipulation of the menstrual cycle

Gonadotrophin releasing hormone agonists (GnRHa)

Superovulation

Gonadotrophin injections

Ovulation triggers

Ultrasound scans

Hormone assays

Oocyte retrieval

Production of a semen sample

Progesterone supplementation

Laboratory phase of IVF treatment

On the day of oocyte collection

On the day after the oocyte collection

On the second day after the oocyte collection

The number of embryos to replace

Embryo transfer

Embryo cryopreservation

The fate of the transferred embryos

The pregnancy test

The success rate of IVF

Negative outcome of IVF treatment

Positive pregnancy test result

The timing of ultrasound scans during pregnancy

Undesirable aspects of IVF treatment

Welfare of IVF babies

Counselling and psychoprophylaxis

Please, tell them to keep in touch!

Conclusion

BIBLIOGRAPHY

9 Intracytoplasmic sperm injection

Introduction

Indications

Provision of sperm for ICSI

Instrumentation

Superovulation and oocyte retrieval

Sperm preparation

Removal of cumulus cells

Preparation of the dish for injection

ICSI

Sperm pick-up from processed samples still containing debris

Fertilization, embryo culture and transfer

ICSI data

Welfare of ICSI babies

Spermatid injection

Conclusion

BIBLIOGRAPHY

10 Surgical sperm retrieval

Introduction

Indications for surgical sperm retrieval

Microepididymal sperm aspiration (MESA)

Percutaneous epididymal sperm aspiration (PESA)

PESA compared with MESA

Vas deferens sperm aspiration

Testicular sperm extraction (TESE)

Testicular sperm aspiration (TESA)

In vitro culture of testicular tissue

Strategy for surgical sperm retrieval

Conclusion

BIBLIOGRAPHY

11 Intratubal replacement of gametes and embryos (GIFT, ZIFT)

Introduction

Gamete intrafallopian transfer (GIFT)

Indications

Ovarian stimulation

Oocyte retrieval

Intrafallopian transfer of oocytes and sperm

Conventional IVF of excess oocytes

Aftercare

Zygote intrafallopian transfer (ZIFT)

Treatment outcome following GIFT and ZIFT compared to IVF

The role of GIFT/ZIFT in present day infertility treatment

Conclusion

BIBLIOGRAPHY

12 Intrauterine insemination

Introduction

Trends in artificial insemination

Patient selection

Contraindications

Indications

Insemination with fresh partner sperm

Insemination with frozen partner sperm

Insemination with donor sperm

Ovarian cycle management

Monitoring of follicular development and predicting ovulation

The timing of insemination

The insemination procedure

Success rates

Complications

Conclusion

BIBLIOGRAPHY

13 Cryopreservation of gametes, ovarian tissue, testicular tissue and embryos; frozen embryo replacement

Introduction

Principles of cryopreservation

Steps in cryopreservation and thawing

Cryopreservation of sperm

Cryopreservation of testicular tissue

Cryopreservation of oocytes

Cryopreservation of ovarian tissue

Cryopreservation of embryos

Frozen embryo transfer

Conclusion

BIBLIOGRAPHY

14 Assisted hatching

Introduction

Patient selection

Overview of techniques

Partial zona dissection (PZD)

Zona drilling

Lasers

Clinical management

Results of assisted hatching

Conclusion

BIBLIOGRAPHY

15 Preimplantation diagnosis of genetic disease

Introduction

Diseases to screen

Generation of embryos for genetic diagnosis

Theoretical considerations

Present day practice

Oocyte and embryo biopsy techniques

Polar body biopsy

Blastomere biopsy

Blastocyst biopsy

Genetic analytical techniques for PGD

Conclusion

BIBLIOGRAPHY

Appendix

ACRONYMS IN ASSISTED REPRODUCTION TECHNOLOGY

Index