Infertility in practice:
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| Main Author: | |
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| Format: | Book |
| Language: | English |
| Published: |
Boca Raton ; London ; New York
CRC Press
2023
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| Edition: | Fifth edition |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis Klappentext |
| Physical Description: | xvii, 434 Seiten Illustrationen |
| ISBN: | 9780367557447 9780367557454 |
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| 245 | 1 | 0 | |a Infertility in practice |c Adam H. Balen |
| 250 | |a Fifth edition | ||
| 264 | 1 | |a Boca Raton ; London ; New York |b CRC Press |c 2023 | |
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| 650 | 2 | |a Infertilité - Diagnostic | |
| 650 | 2 | |a Infertilité - Thérapeutique | |
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| 650 | 7 | |a Stérilité - Thérapeutique |2 ram | |
| 650 | 4 | |a Human reproductive technology | |
| 650 | 4 | |a Infertility | |
| 650 | 4 | |a Infertility |x diagnosis | |
| 650 | 4 | |a Infertility |x therapy | |
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Record in the Search Index
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| adam_text | Contents Foreword....................................................................................................................................................xin Richard S. Legro Preface........................................................................................................................................................ xv About the Author.................................................................................................................................... xviii 1. Epidemiology of Infertility, 21st-Century Considerations and the Covid-19 Pandemic................................................................................................................ 1 1.1 Introduction............................................................................................................................... 1 1.2 Ovarian Ageing.......................................................................................................................... 1.3 At What Age Should Couples Start Trying for aFamily?......................................................... 4 1.4 Fertility Education................................................................................................................... 1 1.5 Measuring Infertility and Response to Treatment..................................................................... 5 1.6 Definition of Infertility.............................................................................................................. 6 1.7 Is Infertility Becoming More
Common?................................................................................. 0 1.8 Is Infertility on the Rise?......................................................................................................... 1.9 Principles of Infertility Treatment............................................................................................. ° 1.10 Covid-19 and Fertility............................................................................................................... - 2. Prevention of Infertility.................................................................................................................. i? 2.1 Introduction............................................................................................................................. 12 2.2 Impact of Age on Male and Female Fertility........................................................................ ! 2 2.3 Can Women Protect Fertilityagainst Ageing?.......................................................................... 1J 2.4 Contraception......................................................................................................................... 2.5 Environmental Pollutants..................................................................................................... 2.6 Are Sperm Counts Falling?.................................................................................................... ! 6 2.7 Hypospadias, Cryptorchidism and Testicular Cancer............................................................ ! 7 2.8
Conclusion................................................................................................................................; 8 3. Planning a Pregnancy and Preconception Care........................................................................... ֊i 3.1 Introduction........................................................................................................................... 21 3.2 A Preconception Healthcare Programme............................................................................. 2 i 3.3 Body Weight........................................................................................................................... 22 3.4 Dietary Advice for Women Wishingto Conceive.................................................................. 23 3.5 Folic Acid (Folate).................................................................................................................. 24 3.6 Exercise................................................................................................................................... 25 3.7 Supplements for Male Fertility............................................................................................... 25 3.8 Special Diets for Sex Selection............................................................................................... 26 3.9 The Microbiome...................................................................................................................... 26 3.10 Oral
Health.............................................................................................................................. 27 3.11 Smoking, Alcohol and RecreationalDrugs............................................................................. 27 3.12 Anabolic Androgenic Steroids................................................................................................ 29 3.13 Acquired Infections................................................................................................................ 29 3.14 Medical Conditions and Drugs............................................................................................... 30 3.15 Endocrine Disorders............................................................................................................... 30 3.16 Diabetes.................................................................................................................................. 33 3.17 Psychiatric Disorders.............................................................................................................. 33 vi
Contents vii 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 Neurological Disorders........................................................................................................... 34 Gastrointestinal Disease......................................................................................................... 35 Renal Disease.......................................................................................................................... 36 Cardiovascular Disease........................................................................................................... 36 Respiratory Disease................................................................................................................ 37 Antibiotics and Anti-Infective Agents.................................................................................... 37 Haematological Problems....................................................................................................... 39 Connective Tissue Disorders.................................................................................................. 40 Chemotherapy.......................................................................................................................... 41 4 . Obesity and Reproduction......................................................................................................... 46 4.1 Introduction............................................................................................................................. 46 4.2 Defining Obesity and the Extent of the
Problem................................................................... 46 4.3 Influence of Obesity on Natural Fertility............................................................................... 48 4.4 Obesity and Polycystic Ovary Syndrome............................................................................... 49 4.5 Effect of Obesity on Treatment of Anovulatory Infertility....................................................49 4.6 Effect of Obesity on IVF and Related Treatments................................................................. 50 4.7 Effect of Obesity on Pregnancy.............................................................................................. 51 4.8 Provision of Support in Achieving Weight Loss.................................................................... 51 4.9 Guidelines for Accessing Treatment....................................................................................... 52 5 Investigating Infertility.................................................................................................................. 56 5.1 Introduction............................................................................................................................. 56 5.2 General Investigations............................................................................................................ 56 5.3 Investigating the Female Partner............................................................................................ 57 5.4 Diagnosis of Anovulatory
Infertility...................................................................................... 61 5.5 Endocrine Profile.................................................................................................................... 64 5.6 Progesterone............................................................................................................................ 66 5.7 Follicle-Stimulating Hormone................................................................................................ 66 5.8 Ovarian Reserve Tests............................................................................................................ 66 5.9 Luteinising Hormone.............................................................................................................. 68 5.10 Androgens............................................................................................................................... 69 5.11 Thyroid Function.................................................................................................................... 70 5.12 Prolactin.................................................................................................................................. 71 5.13 Oestrogen.................................................................................................................................71 5.14 Glucose Tolerance................................................................................................................... 71 5.15 Other
Investigations................................................................................................................ 72 5.16 Pelvic Ultrasound.................................................................................................................... 72 5.17 Ovarian Morphology.............................................................................................................. 73 5.18 Differentiating between PCOM and PCOS............................................................................ 74 5.19 Ovarian Cysts.......................................................................................................................... 79 5.20 Endometrial Assessment......................................................................................................... 82 5.21 Doppler Ultrasound in Assisted Conception.......................................................................... 83 5.22 Assessment of Tubal Patency and the Uterine Cavity........................................................... 83 5.23 Ultrasound Contrast Hysterosalpingography or Hysterosalpingo Contrast Sonography............................................................................................................................ 89 5.24 Selective Salpingography and Falloposcopy..........................................................................93 5.25 Laparoscopy and Hysteroscopy.............................................................................................. 94 5.26 Transvaginal
Hydroculdoscopy/Hydrolaparoscopy/Salpingoscopy...................................... 98 5.27 Choosing between HSG and Laparoscopy.............................................................................98 5.28 MRI/Computed Tomography Scans....................................................................................... 98 5.29 Investigating the Male Partner................................................................................................ 98 5.30 Semen Analysis...................................................................................................................... 101
viii Contents 5.3 i 5.32 5.33 5.34 5.35 5.36 5.37 5.38 5.39 5.40 5.41 Reduced Sperm Concentration (Oligozoospermia)............................................................... 104 Impaired Sperm Morphology (Teratozoospermia).................................................................104 Reduced Sperm Motility (Asthenozoospermia).....................................................................104 Sperm Dysfunction and DNA Fragmentation........................................................................ 106 Leukospermia.......................................................................................................................... 106 Cervical Mucus Penetration and the Post-Coital Test.......................................................... 107 Anti sperm Antibodies............................................................................................................ 107 Serum Endocrinology in the Male......................................................................................... 107 Chromosomal Analysis.......................................................................................................... 108 Imaging in Male Infertility.................................................................................................... ì08 Testicular Exploration and Biopsy......................................................................................... 109 6. Anovulatory Infertility and Ovulation Induction....................................................................... i 16 6.1
Introduction............................................................................................................................. i 16 6.2 Primary and Secondary Amenorrhoea.................................................................................. 1 7 6.3 Pituitary and Hypothalamic Causes of Anovulation.............................................................120 6.4 Hypogonadotrophic Hypogonadism...................................................................................... 120 6.5 Weight-Related Amenorrhoea............................................................................................... 125 6.6 Systemic Disorders Leading to Anovulation......................................................................... ! 28 6.7 Exercise-Related Amenorrhoea.............................................................................................. ¡29 6.8 Hyperprolactinaemia...............................................................................................................10 6.9 Polycystic Ovary Syndrome.................................................................................................... 135 6.10 Summary.................................................................................................................................. 162 7. Polycystic Ovary Syndrome............................................................................................................ ΓΌ 7.1 Introduction.............................................................................................................................. Г0
7.2 What Is PCOS?........................................................................................................................ 171 7.3 Pathophysiology of PCOS........................................................................................................ !72 7.4 Ovarian Biochemistry.............................................................................................................. 173 7.5 Hypothalamic-Pituitary-Ovarian Axis................................................................................... ¡76 7.6 Hyperinsulinaemia................................................................................................................... ! 79 7.7 Definitions and Heterogeneity of PCOS............................................................................... Ľ0 7.8 Prevalence of PCOS and Ethnic Variations............................................................................ 183 7.9 PCOS in Adolescence.............................................................................................................. 185 7.10 Management of Non-Fertility Aspects of PCOS.................................................................... 186 7.11 Psychological Support and Quality of Life............................................................................. 186 7.12 Obesity..................................................................................................................................... 186 7.13 Menstrual
Irregularity............................................................................................................. 188 7.14 Hyperandrogenism and Hirsutism.......................................................................................... 188 7.15 Reproductive Health in PCOS.............................................................................................. 190 7.16 Health Consequences of PCOS.............................................................................................. 191 7.17 PCOS and Cancer.................................................................................................................... 194 7.18 Conclusion.............................................................................................................................. 195 8. Premature Ovarian Insufficiency and Oocyte Donation........................................................... 203 8.1 Introduction............................................................................................................................. 203 8.2 Control of Ovarian Ageing..................................................................................................... 203 8.3 Incipient POI (“Resistant Ovary Syndrome”)....................................................................... 205 8.4 Diagnosis of POI..................................................................................................................... 205 8.5 Causes of
POI......................................................................................................................... 206 8.6 Management of POI................................................................................................................ 209 8.7 Oocyte Donation......................................................................................................................210 8.8 Experimental Approaches to Combatting POI....................................................................... 211
Contents ix 9. Endometriosis............................................................................................................................... 215 9.1 Introduction......................................................................................................................... 215 9.2 Diagnosis............................................................................................................................. 215 9.3 Non-Invasive Testing for Biomarkers of Endometriosis..................................................... 218 9.4 Classification of Endometriosis.......................................................................................... 218 9.5 Biopsy..................................................................................................................................218 9.6 Cysts.....................................................................................................................................219 9.7 Management of Endometriosis........................................................................................... 222 9.8 Medical Therapy for Fertility............................................................................................. 223 9.9 Surgical Therapy................................................................................................................. 224 9.10 Endometriosis and IVF....................................................................................................... 226 9.11
Adenomyosis....................................................................................................................... 227 9.12 Proposed Strategy for Management of Endometriosis...................................................... 227 10. Tubal Infertility, Fibroids and Uterine Factors........................................................................ 231 10.1 Introduction......................................................................................................................... 231 10.2 Uterine Problems: Congenital Anomalies, Septa, Fibroids, Polyps, Adhesions and Uterine Anomalies........................................................................................................ 243 11. Male Factor Infertility................................................................................................................. 254 11.1 Introduction......................................................................................................................... 254 11.2 General Lifestyle Factors.................................................................................................... 255 11.3 Drugs................................................................................................................................... 255 11.4 Chemotherapy and Radiotherapy.......................................................................................256 11.5 Occupational Factors.......................................................................................................... 256 11.6 Anabolic
Steroids................................................................................................................ 256 11.7 Cannabis and Other Recreational Drugs............................................................................256 11.8 Hypospadias, Cryptorchidism and Testicular Cancer....................................................... 256 11.9 Orchitis and Prophylactic Mumps, Measles, Rubella Vaccination.................................... 257 11.10 Sexually Transmitted Infections......................................................................................... 258 11.11 Testicular Trauma............................................................................................................... 258 11.12 Hypogonadism.................................................................................................................... 258 11.13 Oligoasthenozoospermia..................................................................................................... 259 11.14 Frequency of Intercourse....................................................................................................260 11.15 Leukospermia..................................................................................................................... 260 11.16 Oxidative Stress and ROS................................................................................................... 260 11.17 Varicocele........................................................................................................................... 261 11.18 Antisperm
Antibodies......................................................................................................... 262 11.19 Obstructive Azoospermia................................................................................................... 264 11.20 Congenital Bilateral Absence of the Vasa Deferentia....................................................... 264 11.21 Young’s Syndrome.............................................................................................................. 265 11.22 Kartagener’s Syndrome...................................................................................................... 265 11.23 Surgical Trauma and Vasectomy........................................................................................ 265 11.24 Microsurgical Reconstruction of the Vasa........................................................................ 265 11.25 Idiopathic Male Factor Infertility.......................................................................................267 11.26 Paternal Ageing................................................................................................................... 269 11.27 Coital Dysfunction and Psychosexual Problems............................................................... 269 11.28 Hypergonadotrophic Testicular Failure.............................................................................. 270 11.29 IUI, IVF and ICSI............................................................................................................... 271 11.30 Androgen Insensitivity
Syndrome...................................................................................... 271 11.31 Donor Insemination............................................................................................................ 271
x Contents 12. Unexplained Infertility.................................................................................................................. 278 12.1 Introduction............................................................................................................................. 278 12.2 Assessing the Cause of Infertility.......................................................................................... 278 12.3 Management of Unexplained Infertility................................................................................ 280 12.4 Clomifene Citrate................................................................................................................. 280 12.5 Letrozole.............................................................................................................................. 280 12.6 IUI......................................................................................................................................... 281 12.7 Gamete Intrafallopian Transfer..............................................................................................282 12.8 IVF........................................................................................................................................282 12.9 Strategy for Management of Unexplained Infertility..........................................................283 13. In Vitro Fertilisation.......................................................................................................................285 13.1
Introduction.......................................................................................................................... 285 13.2 Indications for IVF.............................................................................................................. 285 13.3 Viral Screening before Assisted ConceptionTherapies...................................................... 286 13.4 IVF........................................................................................................................................ 286 13.5 Regimens for IVF................................................................................................................ 287 13.6 Dosing of Stimulation for IVF............................................................................................. 291 13.7 Monitoring the IVF Cycle and Ovarian Response to Stimulation..................................... 292 13.8 Ovarian Reserve and Prediction of Response toStimulation............................................. 294 13.9 Poor Responders...................................................................................................................294 13.10 Response of the Polycystic Ovary to Stimulationfor IVF................................................... 295 13.11 Oocyte Retrieval................................................................................................................... 30! 13.12 Embryo Culture and Embryo Transfer................................................................................ 30! 13.13 Number of Embryos for
Transfer......................................................................................... 306 13.14 ICSI for Severe Male Factor Infertility................................................................................ 30° 13.15 The Embryo Transfer Procedure.......................................................................................... 312 13.16 Endometrial Assessment....................................................................................................... 312 13.17 The Endometrial Scratch...................................................................................................... 313 13.18 Luteal-Phase Support after IVF............................................................................................313 13.19 The Frozen Embryo Replacement Cycle............................................................................. 314 13.20 Pregnancy Rates after IVF................................................................................................... 315 13.21 Oocyte Donation................................................................................................................... 3 U 13.22 Surrogacy.............................................................................................................................. 317 13.23 The Human Fertilisation and Embryology Authority and Regulation in the United Kingdom..................................................................................................................... 318 14. Fertility
Preservation...................................................................................................................... 329 14.1 Cryopreservation of Gametes and Embryos.......................................................................... 329 14.2 In Vitro Growth of Follicles....................................................................................................332 14.3 Protection of the Ovaries against Chemotherapy.................................................................. 332 14.4 Testicular Tissue Freezing..................................................................................................... 332 14.5 Transgender Fertility Preservation........................................................................................ 333 15. Pre-Implantation Genetic Testing and Emerging Technologies............................................... 335 15.1 Pre-Implantation Genetic Testing.......................................................................................... 335 15.2 Modes of Inheritance..............................................................................................................337 15.3 The Process ofPGT................................................................................................................337 15.4 PGT-A..................................................................................................................................... 340 15.5 Supernatant Testing................................................................................................................ 343
15.6 Emerging Technologies......................................................................................................... 344
Contents xi 16. Complications of Ovarian Stimulation....................................................................................... 348 16.1 Introduction......................................................................................................................... 348 16.2 Drug-Specific Side Effects.................................................................................................. 348 16.3 The Ovarian Hyperstimulation Syndrome......................................................................... 350 16.4 Multiple Pregnancy............................................................................................................. 358 16.5 The Risk of Cancers in Subfertile Populations and after Fertility Treatment....................359 17. Counselling and Modern Families.............................................................................................. 364 17.1 Introduction......................................................................................................................... 364 17.2 Infertility and Subfertility................................................................................................... 364 17.3 Psychosexual Problems....................................................................................................... 365 17.4 How to Deal with Work...................................................................................................... 366 17.5 Special Needs of the Male Partner..................................................................................... 366 17.6
Adjustment to Parenthood.................................................................................................. 367 17.7 How to Tell Children of Donated Gametes........................................................................ 367 17.8 Surrogacy.............................................................................................................................367 17.9 Modern Families................................................................................................................. 368 17.10 Transgender Pregnancies.................................................................................................... 368 17.11 Emotional Support for Clinic Staff..................................................................................... 369 17.12 The Infertility Counsel lor................................................................................................... 369 17.13 Welfare of the Child............................................................................................................ 370 18. Ethical and Religious Issues......................................................................................................... 372 18.1 Introduction......................................................................................................................... 372 18.2 Does Everyone Have a Right to Treatment?....................................................................... 373 18.3 Biological
Considerations................................................................................................... 373 18.4 Moral Status of the Embryo................................................................................................ 374 18.5 Is IVF Ethical?.................................................................................................................... 374 18.6 Experiments on Human Embryos, Cloning and Stem Cell Research................................ 375 18.7 Donors and Donation.......................................................................................................... 376 18.8 Sex Selection........................................................................................................................377 18.9 Fetal Reduction................................................................................................................... 378 18.10 Should Older Women Be Offered IVF?............................................................................. 378 18.11 Religious Perspectives........................................................................................................ 379 18.12 Conclusion........................................................................................................................... 380 19. Health Outcomes of Children Born after Assisted Conception...............................................382 19.1 Introduction........................................................................................................................... 382 19.2 Manipulated
Gametes........................................................................................................... 382 19.3 IVF........................................................................................................................................ 382 19.4 ICSI....................................................................................................................................... 384 19.5 Imprinting Disorders............................................................................................................385 19.6 Cryopreserved Gametes or Embryos....................................................................................385 20. Miscarriage and Ectopic Pregnancy........................................................................................... 388 20.1 Introduction........................................................................................................................... 388 20.2 Incidence of Miscarriage......................................................................................................388 20.3 Parental Age.......................................................................................................................... 388 20.4 Health Conditions, Lifestyle Factors and Risks of Miscarriage.......................................... 389 20.5 Diagnosis of Pregnancy........................................................................................................ 390 20.6 Prevention of
Miscarriage..................................................................................................... 391 20.7 Management of Miscarriage................................................................................................. 391 20.8 Ectopic Pregnancy................................................................................................................ 391
xii Contents 20.9 Diagnosis of Ectopic Pregnancy........................................................................................... 392 20.10 Management of Ectopic Pregnancy...................................................................................... 392 20.11 Counselling and Support.......................................................................................................397 21. Recurrent Miscarriage and Recurrent Implantation Failure.................................................. 400 21.1 Introduction............................................................................................................................ 400 21.2 Classification of Recurrent Miscarriage...............................................................................400 21.3 Nutritional Causes..................................................................................................................401 21.4 Environmental Factors.......................................................................................................... 401 21.5 Genetic Causes.......................................................................................................................402 21.6 Anatomical Abnormalities.................................................................................................... 402 21.7 Infection and the Microbiome.............................................................................................. 403 21.8 Endocrine
Abnormalities...................................................................................................... 403 21.9 Luteal-Phase Defects and Progesterone Therapy................................................................. 403 21.10 Thrombophilias..................................................................................................................... 404 21.11 Immunological Causes of Recurrent Miscarriage................................................................405 21.12 Summary of the Investigation and Management of Couples with Recurrent Miscarriage................................................................................................................ 4o6 21.13 Recurrent Implantation Failure............................................................................................. 406 22. Alternative Therapies and “Add-Ons”.........................................................................................410 23. When to Stop Treatment and Other Options.............................................................................. 413 23.1 Introduction............................................................................................................................ 413 23.2 Adoption................................................................................................................................. 414 23.3 Adopting a Child from Overseas............................................................................................И 5 23.4
Fostering................................................................................................................................ 415 23.5 Respite Care............................................................................................................................ 116 Appendix: Daily Vitamin and Mineral Requirements (See Chapter 3)........................................... 417 Books for Further Reading....................................................................................................................420 Index......................................................................................................................................................... 422
This text has been written as a practical guide, based on the author’s experience over the last 40 years of daily clinical practice, and aims to place the modern approach to the management of infertility in the context of sound theory and evidence-based therapy. It provides the reader with a comprehensive classification of the causes of infertility, their investigation and their management. This new edition covers many advances in the understanding and management of infertility and other updates to practice - for example, a greater understanding of the pathophysiology of ovarian ageing and ovarian reserve testing, the classification of disorders of ovulation and management of polycystic ovary syndrome, the refinement of regimens for superovulation, improved embryo culture systems and the use of artificial intelligence for the selection of embryos, assessments for endometrial receptivity and management of recurrent implantation failure, and pre-implantation genetic testing (PGT) as a therapeutic tool, opening up the possibility for aneuploidy screening, as well as the latest thoughts on nutritional health, periconception care and the exciting new world of the microbiome.
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Contents Foreword.xin Richard S. Legro Preface. xv About the Author. xviii 1. Epidemiology of Infertility, 21st-Century Considerations and the Covid-19 Pandemic. 1 1.1 Introduction. 1 1.2 Ovarian Ageing. 1.3 At What Age Should Couples Start Trying for aFamily?. 4 1.4 Fertility Education. 1 1.5 Measuring Infertility and Response to Treatment. 5 1.6 Definition of Infertility. 6 1.7 Is Infertility Becoming More
Common?. 0 1.8 Is Infertility on the Rise?. 1.9 Principles of Infertility Treatment. ° 1.10 Covid-19 and Fertility. - 2. Prevention of Infertility. i? 2.1 Introduction. 12 2.2 Impact of Age on Male and Female Fertility. ! 2 2.3 Can Women Protect Fertilityagainst Ageing?. 1J 2.4 Contraception. 2.5 Environmental Pollutants. 2.6 Are Sperm Counts Falling?. ! 6 2.7 Hypospadias, Cryptorchidism and Testicular Cancer. ! 7 2.8
Conclusion.; 8 3. Planning a Pregnancy and Preconception Care. ֊i 3.1 Introduction. 21 3.2 A Preconception Healthcare Programme. 2 i 3.3 Body Weight. 22 3.4 Dietary Advice for Women Wishingto Conceive. 23 3.5 Folic Acid (Folate). 24 3.6 Exercise. 25 3.7 Supplements for Male Fertility. 25 3.8 Special Diets for Sex Selection. 26 3.9 The Microbiome. 26 3.10 Oral
Health. 27 3.11 Smoking, Alcohol and RecreationalDrugs. 27 3.12 Anabolic Androgenic Steroids. 29 3.13 Acquired Infections. 29 3.14 Medical Conditions and Drugs. 30 3.15 Endocrine Disorders. 30 3.16 Diabetes. 33 3.17 Psychiatric Disorders. 33 vi
Contents vii 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 Neurological Disorders. 34 Gastrointestinal Disease. 35 Renal Disease. 36 Cardiovascular Disease. 36 Respiratory Disease. 37 Antibiotics and Anti-Infective Agents. 37 Haematological Problems. 39 Connective Tissue Disorders. 40 Chemotherapy. 41 4 . Obesity and Reproduction. 46 4.1 Introduction. 46 4.2 Defining Obesity and the Extent of the
Problem. 46 4.3 Influence of Obesity on Natural Fertility. 48 4.4 Obesity and Polycystic Ovary Syndrome. 49 4.5 Effect of Obesity on Treatment of Anovulatory Infertility.49 4.6 Effect of Obesity on IVF and Related Treatments. 50 4.7 Effect of Obesity on Pregnancy. 51 4.8 Provision of Support in Achieving Weight Loss. 51 4.9 Guidelines for Accessing Treatment. 52 5 Investigating Infertility. 56 5.1 Introduction. 56 5.2 General Investigations. 56 5.3 Investigating the Female Partner. 57 5.4 Diagnosis of Anovulatory
Infertility. 61 5.5 Endocrine Profile. 64 5.6 Progesterone. 66 5.7 Follicle-Stimulating Hormone. 66 5.8 Ovarian Reserve Tests. 66 5.9 Luteinising Hormone. 68 5.10 Androgens. 69 5.11 Thyroid Function. 70 5.12 Prolactin. 71 5.13 Oestrogen.71 5.14 Glucose Tolerance. 71 5.15 Other
Investigations. 72 5.16 Pelvic Ultrasound. 72 5.17 Ovarian Morphology. 73 5.18 Differentiating between PCOM and PCOS. 74 5.19 Ovarian Cysts. 79 5.20 Endometrial Assessment. 82 5.21 Doppler Ultrasound in Assisted Conception. 83 5.22 Assessment of Tubal Patency and the Uterine Cavity. 83 5.23 Ultrasound Contrast Hysterosalpingography or Hysterosalpingo Contrast Sonography. 89 5.24 Selective Salpingography and Falloposcopy.93 5.25 Laparoscopy and Hysteroscopy. 94 5.26 Transvaginal
Hydroculdoscopy/Hydrolaparoscopy/Salpingoscopy. 98 5.27 Choosing between HSG and Laparoscopy.98 5.28 MRI/Computed Tomography Scans. 98 5.29 Investigating the Male Partner. 98 5.30 Semen Analysis. 101
viii Contents 5.3 i 5.32 5.33 5.34 5.35 5.36 5.37 5.38 5.39 5.40 5.41 Reduced Sperm Concentration (Oligozoospermia). 104 Impaired Sperm Morphology (Teratozoospermia).104 Reduced Sperm Motility (Asthenozoospermia).104 Sperm Dysfunction and DNA Fragmentation. 106 Leukospermia. 106 Cervical Mucus Penetration and the Post-Coital Test. 107 Anti sperm Antibodies. 107 Serum Endocrinology in the Male. 107 Chromosomal Analysis. 108 Imaging in Male Infertility. ì08 Testicular Exploration and Biopsy. 109 6. Anovulatory Infertility and Ovulation Induction. i 16 6.1
Introduction. i 16 6.2 Primary and Secondary Amenorrhoea. 1 7 6.3 Pituitary and Hypothalamic Causes of Anovulation.120 6.4 Hypogonadotrophic Hypogonadism. 120 6.5 Weight-Related Amenorrhoea. 125 6.6 Systemic Disorders Leading to Anovulation. ! 28 6.7 Exercise-Related Amenorrhoea. ¡29 6.8 Hyperprolactinaemia.10 6.9 Polycystic Ovary Syndrome. 135 6.10 Summary. 162 7. Polycystic Ovary Syndrome. ΓΌ 7.1 Introduction. Г0
7.2 What Is PCOS?. 171 7.3 Pathophysiology of PCOS. !72 7.4 Ovarian Biochemistry. 173 7.5 Hypothalamic-Pituitary-Ovarian Axis. ¡76 7.6 Hyperinsulinaemia. ! 79 7.7 Definitions and Heterogeneity of PCOS. Ľ0 7.8 Prevalence of PCOS and Ethnic Variations. 183 7.9 PCOS in Adolescence. 185 7.10 Management of Non-Fertility Aspects of PCOS. 186 7.11 Psychological Support and Quality of Life. 186 7.12 Obesity. 186 7.13 Menstrual
Irregularity. 188 7.14 Hyperandrogenism and Hirsutism. 188 7.15 Reproductive Health in PCOS. 190 7.16 Health Consequences of PCOS. 191 7.17 PCOS and Cancer. 194 7.18 Conclusion. 195 8. Premature Ovarian Insufficiency and Oocyte Donation. 203 8.1 Introduction. 203 8.2 Control of Ovarian Ageing. 203 8.3 Incipient POI (“Resistant Ovary Syndrome”). 205 8.4 Diagnosis of POI. 205 8.5 Causes of
POI. 206 8.6 Management of POI. 209 8.7 Oocyte Donation.210 8.8 Experimental Approaches to Combatting POI. 211
Contents ix 9. Endometriosis. 215 9.1 Introduction. 215 9.2 Diagnosis. 215 9.3 Non-Invasive Testing for Biomarkers of Endometriosis. 218 9.4 Classification of Endometriosis. 218 9.5 Biopsy.218 9.6 Cysts.219 9.7 Management of Endometriosis. 222 9.8 Medical Therapy for Fertility. 223 9.9 Surgical Therapy. 224 9.10 Endometriosis and IVF. 226 9.11
Adenomyosis. 227 9.12 Proposed Strategy for Management of Endometriosis. 227 10. Tubal Infertility, Fibroids and Uterine Factors. 231 10.1 Introduction. 231 10.2 Uterine Problems: Congenital Anomalies, Septa, Fibroids, Polyps, Adhesions and Uterine Anomalies. 243 11. Male Factor Infertility. 254 11.1 Introduction. 254 11.2 General Lifestyle Factors. 255 11.3 Drugs. 255 11.4 Chemotherapy and Radiotherapy.256 11.5 Occupational Factors. 256 11.6 Anabolic
Steroids. 256 11.7 Cannabis and Other Recreational Drugs.256 11.8 Hypospadias, Cryptorchidism and Testicular Cancer. 256 11.9 Orchitis and Prophylactic Mumps, Measles, Rubella Vaccination. 257 11.10 Sexually Transmitted Infections. 258 11.11 Testicular Trauma. 258 11.12 Hypogonadism. 258 11.13 Oligoasthenozoospermia. 259 11.14 Frequency of Intercourse.260 11.15 Leukospermia. 260 11.16 Oxidative Stress and ROS. 260 11.17 Varicocele. 261 11.18 Antisperm
Antibodies. 262 11.19 Obstructive Azoospermia. 264 11.20 Congenital Bilateral Absence of the Vasa Deferentia. 264 11.21 Young’s Syndrome. 265 11.22 Kartagener’s Syndrome. 265 11.23 Surgical Trauma and Vasectomy. 265 11.24 Microsurgical Reconstruction of the Vasa. 265 11.25 Idiopathic Male Factor Infertility.267 11.26 Paternal Ageing. 269 11.27 Coital Dysfunction and Psychosexual Problems. 269 11.28 Hypergonadotrophic Testicular Failure. 270 11.29 IUI, IVF and ICSI. 271 11.30 Androgen Insensitivity
Syndrome. 271 11.31 Donor Insemination. 271
x Contents 12. Unexplained Infertility. 278 12.1 Introduction. 278 12.2 Assessing the Cause of Infertility. 278 12.3 Management of Unexplained Infertility. 280 12.4 Clomifene Citrate. 280 12.5 Letrozole. 280 12.6 IUI. 281 12.7 Gamete Intrafallopian Transfer.282 12.8 IVF.282 12.9 Strategy for Management of Unexplained Infertility.283 13. In Vitro Fertilisation.285 13.1
Introduction. 285 13.2 Indications for IVF. 285 13.3 Viral Screening before Assisted ConceptionTherapies. 286 13.4 IVF. 286 13.5 Regimens for IVF. 287 13.6 Dosing of Stimulation for IVF. 291 13.7 Monitoring the IVF Cycle and Ovarian Response to Stimulation. 292 13.8 Ovarian Reserve and Prediction of Response toStimulation. 294 13.9 Poor Responders.294 13.10 Response of the Polycystic Ovary to Stimulationfor IVF. 295 13.11 Oocyte Retrieval. 30! 13.12 Embryo Culture and Embryo Transfer. 30! 13.13 Number of Embryos for
Transfer. 306 13.14 ICSI for Severe Male Factor Infertility. 30° 13.15 The Embryo Transfer Procedure. 312 13.16 Endometrial Assessment. 312 13.17 The Endometrial Scratch. 313 13.18 Luteal-Phase Support after IVF.313 13.19 The Frozen Embryo Replacement Cycle. 314 13.20 Pregnancy Rates after IVF. 315 13.21 Oocyte Donation. 3 U 13.22 Surrogacy. 317 13.23 The Human Fertilisation and Embryology Authority and Regulation in the United Kingdom. 318 14. Fertility
Preservation. 329 14.1 Cryopreservation of Gametes and Embryos. 329 14.2 In Vitro Growth of Follicles.332 14.3 Protection of the Ovaries against Chemotherapy. 332 14.4 Testicular Tissue Freezing. 332 14.5 Transgender Fertility Preservation. 333 15. Pre-Implantation Genetic Testing and Emerging Technologies. 335 15.1 Pre-Implantation Genetic Testing. 335 15.2 Modes of Inheritance.337 15.3 The Process ofPGT.337 15.4 PGT-A. 340 15.5 Supernatant Testing. 343
15.6 Emerging Technologies. 344
Contents xi 16. Complications of Ovarian Stimulation. 348 16.1 Introduction. 348 16.2 Drug-Specific Side Effects. 348 16.3 The Ovarian Hyperstimulation Syndrome. 350 16.4 Multiple Pregnancy. 358 16.5 The Risk of Cancers in Subfertile Populations and after Fertility Treatment.359 17. Counselling and Modern Families. 364 17.1 Introduction. 364 17.2 Infertility and Subfertility. 364 17.3 Psychosexual Problems. 365 17.4 How to Deal with Work. 366 17.5 Special Needs of the Male Partner. 366 17.6
Adjustment to Parenthood. 367 17.7 How to Tell Children of Donated Gametes. 367 17.8 Surrogacy.367 17.9 Modern Families. 368 17.10 Transgender Pregnancies. 368 17.11 Emotional Support for Clinic Staff. 369 17.12 The Infertility Counsel lor. 369 17.13 Welfare of the Child. 370 18. Ethical and Religious Issues. 372 18.1 Introduction. 372 18.2 Does Everyone Have a Right to Treatment?. 373 18.3 Biological
Considerations. 373 18.4 Moral Status of the Embryo. 374 18.5 Is IVF Ethical?. 374 18.6 Experiments on Human Embryos, Cloning and Stem Cell Research. 375 18.7 Donors and Donation. 376 18.8 Sex Selection.377 18.9 Fetal Reduction. 378 18.10 Should Older Women Be Offered IVF?. 378 18.11 Religious Perspectives. 379 18.12 Conclusion. 380 19. Health Outcomes of Children Born after Assisted Conception.382 19.1 Introduction. 382 19.2 Manipulated
Gametes. 382 19.3 IVF. 382 19.4 ICSI. 384 19.5 Imprinting Disorders.385 19.6 Cryopreserved Gametes or Embryos.385 20. Miscarriage and Ectopic Pregnancy. 388 20.1 Introduction. 388 20.2 Incidence of Miscarriage.388 20.3 Parental Age. 388 20.4 Health Conditions, Lifestyle Factors and Risks of Miscarriage. 389 20.5 Diagnosis of Pregnancy. 390 20.6 Prevention of
Miscarriage. 391 20.7 Management of Miscarriage. 391 20.8 Ectopic Pregnancy. 391
xii Contents 20.9 Diagnosis of Ectopic Pregnancy. 392 20.10 Management of Ectopic Pregnancy. 392 20.11 Counselling and Support.397 21. Recurrent Miscarriage and Recurrent Implantation Failure. 400 21.1 Introduction. 400 21.2 Classification of Recurrent Miscarriage.400 21.3 Nutritional Causes.401 21.4 Environmental Factors. 401 21.5 Genetic Causes.402 21.6 Anatomical Abnormalities. 402 21.7 Infection and the Microbiome. 403 21.8 Endocrine
Abnormalities. 403 21.9 Luteal-Phase Defects and Progesterone Therapy. 403 21.10 Thrombophilias. 404 21.11 Immunological Causes of Recurrent Miscarriage.405 21.12 Summary of the Investigation and Management of Couples with Recurrent Miscarriage. 4o6 21.13 Recurrent Implantation Failure. 406 22. Alternative Therapies and “Add-Ons”.410 23. When to Stop Treatment and Other Options. 413 23.1 Introduction. 413 23.2 Adoption. 414 23.3 Adopting a Child from Overseas.И 5 23.4
Fostering. 415 23.5 Respite Care. 116 Appendix: Daily Vitamin and Mineral Requirements (See Chapter 3). 417 Books for Further Reading.420 Index. 422
This text has been written as a practical guide, based on the author’s experience over the last 40 years of daily clinical practice, and aims to place the modern approach to the management of infertility in the context of sound theory and evidence-based therapy. It provides the reader with a comprehensive classification of the causes of infertility, their investigation and their management. This new edition covers many advances in the understanding and management of infertility and other updates to practice - for example, a greater understanding of the pathophysiology of ovarian ageing and ovarian reserve testing, the classification of disorders of ovulation and management of polycystic ovary syndrome, the refinement of regimens for superovulation, improved embryo culture systems and the use of artificial intelligence for the selection of embryos, assessments for endometrial receptivity and management of recurrent implantation failure, and pre-implantation genetic testing (PGT) as a therapeutic tool, opening up the possibility for aneuploidy screening, as well as the latest thoughts on nutritional health, periconception care and the exciting new world of the microbiome. |
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| author | Balen, Adam H. |
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| bvnumber | BV048624408 |
| callnumber-first | R - Medicine |
| callnumber-label | RC889 |
| callnumber-raw | RC889 |
| callnumber-search | RC889 |
| callnumber-sort | RC 3889 |
| callnumber-subject | RC - Internal Medicine |
| classification_rvk | YM 2500 YM 2501 |
| ctrlnum | (OCoLC)1369551448 (DE-599)BVBBV048624408 |
| dewey-full | 618.1/78 |
| dewey-hundreds | 600 - Technology (Applied sciences) |
| dewey-ones | 618 - Gynecology, obstetrics, pediatrics, geriatrics |
| dewey-raw | 618.1/78 |
| dewey-search | 618.1/78 |
| dewey-sort | 3618.1 278 |
| dewey-tens | 610 - Medicine and health |
| discipline | Medizin |
| discipline_str_mv | Medizin |
| edition | Fifth edition |
| format | Book |
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| illustrated | Illustrated |
| index_date | 2024-07-03T21:14:25Z |
| indexdate | 2024-07-10T09:43:18Z |
| institution | BVB |
| isbn | 9780367557447 9780367557454 |
| language | English |
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| spelling | Balen, Adam H. Verfasser (DE-588)14361374X aut Infertility in practice Adam H. Balen Fifth edition Boca Raton ; London ; New York CRC Press 2023 xvii, 434 Seiten Illustrationen txt rdacontent n rdamedia nc rdacarrier Infertilité - Diagnostic Infertilité - Thérapeutique Stérilité - Diagnostic ram Stérilité - Thérapeutique ram Human reproductive technology Infertility Infertility diagnosis Infertility therapy Sterilität (DE-588)4057338-2 gnd rswk-swf Therapie (DE-588)4059798-2 gnd rswk-swf Sterilität (DE-588)4057338-2 s Therapie (DE-588)4059798-2 s DE-604 Erscheint auch als Online-Ausgabe 978-1-003-09495-1 Digitalisierung UB Augsburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=033999540&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis Digitalisierung UB Augsburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=033999540&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Klappentext |
| spellingShingle | Balen, Adam H. Infertility in practice Infertilité - Diagnostic Infertilité - Thérapeutique Stérilité - Diagnostic ram Stérilité - Thérapeutique ram Human reproductive technology Infertility Infertility diagnosis Infertility therapy Sterilität (DE-588)4057338-2 gnd Therapie (DE-588)4059798-2 gnd |
| subject_GND | (DE-588)4057338-2 (DE-588)4059798-2 |
| title | Infertility in practice |
| title_auth | Infertility in practice |
| title_exact_search | Infertility in practice |
| title_exact_search_txtP | Infertility in practice |
| title_full | Infertility in practice Adam H. Balen |
| title_fullStr | Infertility in practice Adam H. Balen |
| title_full_unstemmed | Infertility in practice Adam H. Balen |
| title_short | Infertility in practice |
| title_sort | infertility in practice |
| topic | Infertilité - Diagnostic Infertilité - Thérapeutique Stérilité - Diagnostic ram Stérilité - Thérapeutique ram Human reproductive technology Infertility Infertility diagnosis Infertility therapy Sterilität (DE-588)4057338-2 gnd Therapie (DE-588)4059798-2 gnd |
| topic_facet | Infertilité - Diagnostic Infertilité - Thérapeutique Stérilité - Diagnostic Stérilité - Thérapeutique Human reproductive technology Infertility Infertility diagnosis Infertility therapy Sterilität Therapie |
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