Practical Problems in Assisted Conception

Description

Engage with practical and active solutions to day-to-day issues of reproductive medicine and the use of artificial reproductive techniques (ART), occurring in clinical and laboratory environments. Authored by leading experts in the field, this user-friendly guide is invaluable for any IVF practitioner and embryologist, facing everyday hands-on issues, through to high-pressure laboratory problems, efficiency ratings and ensuring cost-effective delivery of care. With the strict governance of regulatory bodies worldwide, the success of any fertility centre depends on successful problem solving, all day every day. Based on a wealth of experience, identify commonly occurring problems, and fresh perspectives of problem-solving, with 'must-have' protocols, patient information sheets and suggested equipment. This go-to companion tackles operational, organisational, clinical and laboratory issues to financial and clinical governance, with a focus on quick and effective solutions for the busy practitioner. Practical Problems in Assisted Conception......Page 1 Half Title......Page 3 Title Page......Page 5 Copyright......Page 6 Contents......Page 7 Contributors......Page 9 Chapter 1 A Lifetime Observations and Reflections as an IVF Doctor......Page 13 References......Page 16 Chapter 2 The Patient Perspective of Assisted Reproduction......Page 17 Data from Published Systematic Reviews......Page 19 Significance of Size of Fibroids......Page 20 Conclusions and a Practical Approach to Management in Clinical Practice......Page 21 References......Page 22 Which Follicle-Stimulating Hormone to Use......Page 23 What Dosage to Give......Page 24 References......Page 25 Predictive Tests of Poor Response......Page 26 Stimulation Protocols Used in Poor Responders......Page 27 Adjuvant Therapies for Poor Responder Patients......Page 28 Counseling......Page 29 References......Page 30 Background......Page 31 Considerations for Patient Selection......Page 32 Assessment of Risk to Fertility (Table 6.2)......Page 33 Suggested Documentation......Page 34 References......Page 35 Gonadotropin Hormone-Releasing Hormone Agonists......Page 36 Cryopreservation of Unfertilized or Fertilized Oocytes......Page 37 References......Page 38 Diagnosis......Page 40 Surgical Treatment......Page 41 Suggested Audits......Page 42 References......Page 43 Sperm Quality in Older Men......Page 44 Risks to Child Health and Development......Page 45 Suggested Standard Operating Protocol (SOP)......Page 46 References......Page 47 Discussion on Endometrioma-Specific Treatment Options......Page 48 Discussion on Stimulation Protocols and Treatment-Adverse Effects......Page 49 Further Reading......Page 50 References......Page 51 Ultrasound......Page 52 Treatment Hysteroscopic Surgery......Page 53 Foley Catheter......Page 54 Antibiotics......Page 55 References......Page 56 In Vitro Research: Biologically Plausible Mechanisms......Page 58 In Vivo Research: Clinical Trials on Acupuncture and CHM Acupuncture......Page 59 CAM Interventions during IVF......Page 60 References......Page 61 How Does the 揚roblem? Relate to IVF and Vice Versa?......Page 63 Strategies/Solutions......Page 64 References......Page 65 The Patient Who Has a Uterine Abnormality Diagnosed at Tubal Assessment......Page 67 Methods of Tubal Assessment Hysterosalpingography (HSG)......Page 68 Laparoscopy and Dye......Page 70 Fertiloscopy or Transvaginal Hydrolaparoscopy......Page 71 Chlamydia Testing......Page 72 Suggested Audit......Page 73 References......Page 74 Which One Is Better? Single Step or Sequential?......Page 75 Embryo Manipulation and Culture Approaches......Page 76 References......Page 77 How to Set Up and Manage Key Performance Indicators (KPI)......Page 78 Processes......Page 82 Laboratory Equipment......Page 83 Conclusion......Page 84 References......Page 85 Clinical Significance of EMT and Endometrial Pattern Clinical Significance of EMT......Page 86 Clinical Significance of Endometrial Pattern......Page 87 Managing Thin Endometrium in IVF......Page 88 Therapies to Improve Endometrial Perfusion......Page 89 References......Page 90 Pathophysiology......Page 91 Management......Page 93 References......Page 95 Progesterone Preparations and Routes of Administration and Duration of Luteal Support......Page 98 Protocols......Page 101 References......Page 102 Controlled Ovarian Stimulation: Protocols and Regime......Page 104 Pharmacologic Interventions......Page 106 References......Page 107 Cause of Subfertility......Page 109 Anesthetic Management......Page 110 References......Page 112 Preliminary Steps......Page 114 Movement of Aspiration Needle......Page 115 Follicle/Blood Vessel......Page 116 References......Page 117 The Setup......Page 119 Issues Relating to Machine/System Setup......Page 120 Reference......Page 121 Adequate Follicular Recruitment and Development......Page 122 Reduced Human Chorionic Gonadotrophin or Luteinizing Hormone/Progesterone Bioavailability......Page 123 Suggested Audit......Page 124 References......Page 125 Technique for Egg Collection......Page 126 Early Complications......Page 127 References......Page 129 Cervical Mucus and Blood......Page 130 Bladder Filling......Page 131 Cervical Dilatation......Page 132 Avoiding a Difficult Embryo Transfer......Page 133 References......Page 134 Normal Erectile Function and Ejaculation......Page 135 Conservative Measures......Page 136 Surgical Sperm Recovery (SSR)......Page 137 References......Page 138 Identification......Page 139 Identification......Page 140 Identification......Page 141 Resolution......Page 142 References......Page 143 Operator and Protocol......Page 144 Human Factors......Page 145 Patient Demographics......Page 146 Corrective Actions and Preventative Measures......Page 147 Reference......Page 149 Moving Oocytes and Embryos between Dishes......Page 150 Conclusion......Page 153 Acknowledgements......Page 154 Sources of Infection......Page 155 Identification......Page 156 Prevention......Page 157 References......Page 159 Polar Body Biopsy......Page 160 Platform for Couples with Genetic Disorders......Page 161 Mosaicism......Page 162 Should PGD Always Be Coupled with PGS?......Page 163 References......Page 164 Endometrium and Sub-Endometrium......Page 165 Congenital Anomalies......Page 166 Patency......Page 167 Follicle Tracking......Page 168 Conclusion......Page 169 References......Page 170 Lifestyle Changes......Page 171 Improving Embryo Quality and Selection......Page 172 Intra-Cavity Lesion......Page 173 Clinical Trials......Page 174 References......Page 175 What Is Fertilization Failure?......Page 177 Optimizing the Laboratory Environment......Page 178 Conclusion......Page 179 References......Page 180 What Is Poor Embryo Development?......Page 181 Oocytes: Cause of Aneuploidy and Influence on Embryo Development......Page 182 Laboratory: In Vitro Culture and Reprotoxicity......Page 183 Will Poor-Quality Embryos in One Cycle Mean Poor-Quality Embryos in the Subsequent Cycles?......Page 184 References......Page 185 What Is a Quality Management System and Why Have It?......Page 186 The Crucial Elements of the QMS Personnel......Page 187 Document Control......Page 188 Validation......Page 190 Conclusion......Page 191 References......Page 192 Human Performance Is Variable......Page 193 Teamwork......Page 194 Checks and Checklists......Page 195 References......Page 196 Suggestions for Further Reading......Page 197 Positioning and Branding......Page 198 How Are We Going to Get There? Develop a Marketing Plan......Page 199 References......Page 202 Study Setup......Page 203 Data Collection......Page 204 The Referral Process......Page 205 Summary......Page 207 References......Page 208 How to Get Information to Develop a Business Plan......Page 209 Understanding a Business Plan for an IVF Unit Setup......Page 210 Understanding the Business Economics: Profit and Loss Statement......Page 211 Revenue and Costs for an IVF/ Infertility Clinic Revenue from Services......Page 213 Cost of Running an Infertility Center......Page 214 Introduction to a Balance Sheet......Page 215 Which Measure to Use While Setting Up a Business......Page 216 Operational/Strategic Choices (Options) while Setting Up an IVF Business......Page 217 For Further Reading......Page 218 Chapter 42 The Essentials for Building a Great Fertility Team Take Five with Fiona Pringle......Page 219 ART 3.0......Page 221 References......Page 223 Conversation Questions......Page 224 Index......Page 227