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Assisted Reproduction Techniques
Challenges and Management Options
by Khaldoun Sharif, Arri Coomarasamy
Hardback Book (466 Pages)
April 2012
Assisted reproduction techniques have led to the birth of 4 million babies worldwide
Assisted reproduction techniques (ART), in particular in-vitro fertilization and intra-cytoplasmic sperm injection, are the most advanced forms of infertility treatment. They involve numerous counseling, medical, surgical and laboratory-based steps. At each step various problems and complications could be encountered that challenge even the most experienced ART practitioners. Moreover, patients with complex medical disorders may require ART, presenting further challenges.

Assisted Reproduction Techniques will stimulate resourceful thinking in the ART practitioner when faced with these challenges. It outlines various management options, the reasoning behind them, and the evidence on which they are based to enable the practitioner to choose the most suitable solution for the needs of each patient.

Written by 122 internationally renowned experts, Assisted Reproduction Techniques follows the patient's journey throughout the whole ART process, with chapters on:
•Counseling and preparation
•Ovarian stimulation
•Oocyte retrieval
•Embryo transfer
•The luteal phase
•The ART laboratory
•The male patient
•The ART pregnancy

Each of the 100 concise chapters includes clinical cases, background, evidence-based practical management options, preventive measures and key-point summaries of the important details.

Assisted Reproduction Techniques gives a wide-ranging practical guide to all those wishing to support couples who cannot conceive naturally.
Contributors, xi
Preface, xxii

How to use this book, xxiii

Section 1: Counseling and preparation phase

1 Risk of cancer from ovarian stimulation, 3
Nikos Kanakas, Miltiadis Pitsos and Themis Mantzavinos

2 Risk of early menopause following IVF treatment, 7
Sesh Kamal Sunkara

3 The HIV positive female, 9
Joshua U. Klein and Mark V. Sauer

4 The HIV positive male, 13
Mark V. Sauer and Joshua U. Klein

5 The hepatitis B/C carrier patient, 17
Suzanne P.M. Lutgens, I.H.M. Van Loo, E.C.M. Nelissen and G.A.J. Dunselman

6 The patient with cystic fibrosis, 21
Tarek El-Toukhy

7 The patient on medication, 25
Arri Coomarasamy

8 The patient with thrombophilia, 29
Ying C. Cheong and N.S. Macklon

9 The patient with autoimmune disorders, 34
Jos´e Bellver

10 The patient with malignant disease: fertility preservation, 38
Arri Coomarasamy

11 The patient with heart disease, 43
Natasha Thorogood and Catherine Nelson-Piercy

12 The patient with diabetes, 48
Neelam Potdar and Justin C. Konje

13 The patient with thyroid disease, 51
Shiao Chan

14 The patient with hyperprolactinemia, 56
John Ayuk

15 The patient with polycystic ovaries, 61
Adam H. Balen

16 The renal transplant patient and IVF, 65
Lynne Robinson and Clara Day

17 The patient with previous pelvic irradiation, 69
Vishvanath C. Karande

18 Fertility after chemotherapy, 73
Nivedita Reddy

19 The patient with abnormal cervical cytology, 77
Mahmood I. Shafi

20 The patient with previous borderline ovarian tumor, 80
Arri Coomarasamy and Kavita Singh

21 The patient with an endometrioma, 83
Luciano G. Nardo and Oybek Rustamov

22 The patient with cervical stenosis, 86
Khaldoun Sharif

23 Vaccination and ART, 90
Arri Coomarasamy and Dukaydah van der Berg

24 The patient with hydrosalpinx, 95
Annika Strandell

25 The patient with poor ovarian reserve, 99
Scott M. Nelson

26 The patient with congenital uterine anomalies, 105
Sarah Creighton and Lina Michala

27 The patient with congenital cervico-vaginal anomalies, 109
Sarah Creighton and Lina Michala

28 The patient with uterine fibroids, 112
Haitham Hamoda and Yakoub Khalaf

29 The patient with previous Essure® sterilization, 115
T. Justin Clark

30 The patient with previous endometrial ablation, 119
T. Justin Clark

31 The couple with recurrent implantation failure, 124
Tarek El-Toukhy

32 The patient with previous uterine artery embolization, 128
Haitham Hamoda and Yakoub Khalaf

33 Endometrial polyp detected during ART treatment, 131
Arri Coomarasamy

34 The obese patient, 135
Mostafa Metwally and Bolarinde Ola

35 Asherman syndrome, 139
Dan Yu, Enlan Xia and T.C. Li

36 The older patient, 142
William Ledger

37 Requests for mild or natural cycle IVF treatment, 146
Brad B. Swelstad and Suheil J. Muasher

38 The ART patient with psychosexual problems, 150
Sue Elkin

39 The patient needing third-party reproduction, 153
Madhurima Rajkhowa

40 Request for “social egg freezing”, 159
Valerie L. Peddie and Siladitya Bhattacharya

41 The patient with bariatric surgery, 165
Zaher O. Merhi and Harry J. Lieman

Section 2: Pituitary suppression and ovarian stimulation phase

42 Poor response during ovarian stimulation, 171
Lynne Robinson and Arri Coomarasamy

43 Ovarian stimulation for IVF in a patient with previous severe ovarian hyperstimulation syndrome, 175
Khaldoun Sharif

44 Unable to achieve pituitary down-regulation, 178
K. Jayaprakasan and Nick Raine-Fenning

45 The patient discovered pregnant during pituitary down-regulation, 184
Mohammed Khairy Mahmoud and Arri Coomarasamy

46 Ovarian cysts following pituitary down-regulation, 188
Alison Taylor

47 Poor endometrial development, 192
Lynne Robinson and Arri Coomarasamy

48 Missed IVF medications, 201
Lynne Robinson and Arri Coomarasamy

49 The patient with a history of estrogen-receptor positive cancer, 205
Murat So¨nmezer and Kutluk Oktay

50 The patient over-responding to controlled ovarian stimulation during IVF, 208
Khaldoun Sharif

Section 3: Oocyte retrieval

51 General anesthesia or sedation for oocyte retrieval?, 215
Andrew F. Malins

52 Delayed oocyte retrieval, 219
Khaldoun Sharif

53 Empty follicle syndrome, 223
George Ndukwe

54 Bleeding following oocyte retrieval, 227
Annika K. Ludwig and Barbara Sonntag

55 To flush or not to flush follicles at oocyte retrieval?, 232
Micah J. Hill and Eric D. Levens

56 Inaccessible ovaries at oocyte retrieval, 236
Hazem Al-Rumaih

57 Endometriotic cysts at oocyte retrieval, 239
Graciela Kohls and Juan A. Garc´ýa-Velasco

Section 4: Embryo transfer

58 Couple splitting while embryos are in storage, 245
Masoud Afnan

59 Endometrial cavity fluid identified during IVF treatment, 249
Arri Coomarasamy

60 Difficult embryo transfer, 252
Khaldoun Sharif

61 Excessive cervical mucus and retained embryo at embryo transfer, 257
Hassan N. Sallam, Ahmed F. Galal and Fady S. Moeity

62 Life after embryo transfer, 261
Kelton Tremellen

Section 5: The luteal phase

63 Vaginal bleeding in the luteal phase after IVF, 267
Carol Coughlan and Bolarinde Ola

64 Pelvic infection after IVF, 271
Muhammad Faisal Aslam

65 The patient presenting with ovarian hyperstimulation syndrome, 274
Khaldoun Sharif

66 Adnexal torsion after IVF, 279
Saioa Torrealday and Beth W. Rackow

67 Exposure to infection in the luteal phase of IVF, 283
Litha Pepas and Arri Coomarasamy

Section 6: The ART laboratory

68 Total failure of fertilization after conventional IVF - rescue ICSI, 291
A. Albert Yuzpe

69 Couples not wishing to create surplus embryos in IVF, 296
Hossam Mohamed

70 Aneuploidy screening for advanced maternal age or repeated IVF failure, 300
Haitham Hamoda and Yacoub Khalaf

71 Choosing an embryo for transfer, 304
Denny Sakkas

72 Globozoospermia, 308
Steven Mansell, Anne Rice, Catherine Beaton and Christopher L.R. Barratt

73 Total failure of fertilization after ICSI, 313
Kaoru Yanagida

74 Refreezing of embryos, 317
Jerome H. Check

75 Infection in embryo culture medium, 320
Peter M.M. Kastrop

76 ICSI or IVF in nonmale-factor infertility?, 324
Mohamed Aboulghar

77 The ART program during a natural or human-made disaster, 328
Richard P. Dickey and Carla White

78 Using the wrong sperm or embryos in IVF, 331
Khaldoun Sharif and Mutaz Al-Ahmad

Section 7: The male patient

79 Unexpected inability to produce a semen sample on the day of oocyte retrieval, 337
Khaldoun Sharif

80 The azoospermic patient, 340
Khaldoun Sharif

81 ART in men with Klinefelter syndrome, 344
Ronnie G. Fine and Darius A. Paduch

82 ART in men with 100% immotile sperm, 349
Carolina Ortega-Hrepich, Dominique Raick and Herman Tournaye

83 Request for posthumous fatherhood with perimortem surgical sperm retrieval, 353
Zamip P. Patel, Heather E. Ross and Lawrence S. Ross

84 Retrograde ejaculation and anejaculation, 360
Asif Muneer and Anthony Hirsh

85 Sperm retrieval in cancerous testes, 364
Saad Aldousari and Armand Zini

86 Leukocytospermia and ART, 367
Giuseppe Ricci

87 The infertile male patient with a genetic cause, 371
Katherine L. O’Flynn O’Brien and Ashok Agarwal

88 Y chromosome microdeletions and ART, 376
Sherman J. Silber

Section 8: The ART pregnancy

89 Unexpected number or gender of babies after IVF, 383
Khaldoun Sharif

90 Suspected ectopic pregnancy after IVF, 387
Vishvanath C. Karande

91 Cervical ectopic pregnancy after IVF, 391
Usha Verma

92 Heterotopic pregnancy after IVF, 396
Abdel-Maguid Ramzy

93 Multi-fetal pregnancy reduction after ART, 400
R. Katie Morris and Mark D. Kilby

94 Multiple pregnancy after IVF: to cerclage or not to cerclage? 405
Harold Gee

95 Hyperreactio luteinalis after IVF, 409
Mohammad Ebrahim Parsanezhad, Leila Forooghinia and Maryam Parsa-Nezhad

96 Lactation by a commissioning mother in surrogacy, 412
Frank P. Biervliet and Stephen L. Atkin

Section 9: General issues

97 Dealing with the emotional distress following failed IVF, 417
Linda Hammer Burns

98 IVF when the prognosis is very poor or futile, 421
Khaldoun Sharif

99 Unexpected drop in the ART clinic pregnancy rate, 425
Bulent Urman and Kayhan Yakin

100 Natural fertility after IVF, 430
Frank Nawroth and Annika K. Ludwig

Index, 433
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