Cambridge University Press 978-1-108-81783-7 — Reproductive Medicine for the MRCOG Edited by Siladitya Bhattacharya , Mark Hamilton Index More Information

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access, to fertility treatment, 137–40 arcuate uterus, 41 body mass index (BMI), 9, 10 adenomyosis, 33, 40 aromatase inhibitors, 16, 29 bromocriptine, 19 adhesions ART. See assisted reproduction buffers, culture media, 95–6 intrauterine, 33–4, 35, 40, 41 technology tubal, 31 AS. See Asherman’s syndrome cabergoline, 19 adjuvants/add-ons in assisted ASFR. See Age-Specific Fertility Rate calcium ionophores, 89, 103 reproduction, 91 Asherman’s syndrome (AS), 33–4, 35, cancer treatment, 113. See also fertility artificial egg activation with calcium 40, 41 preservation ionophore, 89, 103 ASRM. See American Society for gonadotoxicity risks of, 113, 114 assisted hatching, 86 Reproductive Medicine mechanisms of fertility damage by, background on, 82–3 assessment. See also infertility 114–15 commonly used, 83–4 assessment ovarian reserve damage by, 114–15 costs of, 83 of donors, surrogates and intended pregnancy outcomes after, 120 embryo glue, 88 parents, 129–30 testicular damage caused by, 46, 115 endometrial receptivity array, 87 embryo, 105–6, 107 CAT. See chlamydia antibody testing endometrial scratching, 84–5, 86 of fertilisation, 101–2, 103 catheters, for embryo transfer, 73 GM-CSF-containing culture media, for fertility preservation, 116–17 CBRS. See cross border reproductive 88 assisted hatching, 86 services IMSI, 89, 101–2 assisted reproduction technology CC. See clomiphene citrate PICSI, 89–90, 101–2 (ART), 68. See also adjuvants/add- Centre for Evidence Based Medicine preimplantation genetic screening, ons in assisted reproduction; (CEBM), 150–1 87, 109–10 laboratory procedures in assisted CF. See cystic fibrosis professional and regulatory body reproduction; specific techniques chemical motility enhancers, 98–9 stances on, 83 access to treatment with, 137–40 chemotherapy. See cancer treatment reproductive immunology decision to stop treatment with, children procedures, 90–1 80–1 disclosure of third-party sperm DNA tests, 90 HFEA role in, 80 conception to, 128–9 time-lapse imaging, 85–6, 106 male factor infertility treatment genetic identity of, 144–5 adoption, 138–9 options in, 52–3 interests and welfare of, 80, 129–30, Age-Specific Fertility Rate (ASFR), techniques used in, 68 137–8, 143, 145, 146 1, 3 unsuccessful, 80–1 posthumous, 120–1, 141–3 air, laboratory, 96 audits, 164 risks to IVF/ICSI conceived, 79 alcohol intake, 8–9, 10, 25–6, 46 autonomy, patient, 136, 137, 140–1, chlamydia antibody testing (CAT), 35 American Society for Reproductive 146 Chlamydia trachomatis, 8, 31, 46 Medicine (ASRM), 24 azoospermia class II cabinets, 94, 95 AMH. See anti-mullerian hormone assisted reproduction treatment cleavage stage embryo transfer, 74 andrology. See male factor infertility options for, 52–3 clinical decision making, 147 anejaculation, 46–7 causes of, 45–7 clinical governance, 163 aneuploidy, PGT for, 87, 109–10 medical treatment options for, 51–2 audits, 164 anorgasmia, 47 surgical treatment options for, 52 external review, 165 anovulatory infertility. See ovulation quality inspections, 164 disorders baby design, 146 quality sampling, 164 antibody testing bacterial vaginosis, 8 quality tours, 164–5 chlamydia, 35 bias, 151–2, 153 risk management/risk assessment, sperm, 51 bicornuate uterus, 41 164 thyroid autoantibodies, 8, 9 biomarkers, for endometriosis, 27 clinical practice guidelines, 153–4 anti-mullerian hormone (AMH), 8 biopsy clomiphene citrate (CC), 14–15, 51–2, antioestrogens, 14–15, 118 embryo, 110–11 56 antiprogestogens, 29 testicular, 51 cocaine use, 9 antral follicle count, 8 blastocyst transfer, 74 Cochrane risk of bias tool, 151–2 167

© in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-108-81783-7 — Reproductive Medicine for the MRCOG Edited by Siladitya Bhattacharya , Mark Hamilton Index More Information

Index

COCP. See combined oral disclosure of, 128–9 female, 13 contraceptive pill ethical dilemmas involving, 144–6 male, 45–6, 51–2 cohort total fertility rate (CTFR), 1 future relationship with, 127–8 thyroid, 8, 9 combined oral contraceptive pill implication discussion and endocrine tests, for males, 49, 51 (COCP), 20, 28, 29, 71 counselling for, 130, 131 endometrial polyps, 33, 36, 37, 40 co-morbidities, double jeopardy risks selection of, 127–8 endometrial receptivity array (ERA), for patients with, 140–1 dopamine agonists, 19 87 conception, prediction models for, double jeopardy risks, for patients with endometrial scratching, 84, 85, 86 54–6, 57, 63 co-morbidities, 140–1 endometrioma, 24, 26, 29, 36 confidentiality, 141 dye hydrotubation, 10 endometriosis, 22, 24 congenital anomalies, in children dysmenorrhoea, 24–5, 27 aetiopathogenesis of, 22–4 conceived by IVF/ICSI, 79 dyspareunia, 27 description, distribution and consequentialism, 138 classification of, 24, 25, 26 controlled ovarian stimulation. See EBM. See evidence-based medicine diagnosis of, 26–7, 28 ovarian stimulation ectopic pregnancy, 78 direct transplantation theory of, 23 corticosteroids, 90–1 ED. See erectile dysfunction economic burden of, 27–8 counselling EFI. See endometriosis fertility index epidemiology and risk factors of, before cross border reproductive egg. See oocyte 24–6 treatment, 132, 133 egg activation, artificial, 89, 103 genetic factors in, 23, 26 for donors, surrogates and partners, ejaculation, 43, 46–7, 49 immunological processes in, 23–4 130, 131 ejaculatory ducts, transurethral management of infertility associated for fertility preservation, 121 resection of, 52 with, 28–9 HFEA requirement for, 123, 124–5 elective egg freezing, 143–4 management of pain associated with, implication discussion in, 126, 130, elective single-embryo transfer (eSET), 29 131 108 organisation of care for, 29–30 offer of, 125 embryo, moral status of, 140 ovarian endometrioma, 24, 26, 29, in preparation for treatment, 124 embryo biopsy, 110–11 36 types of, 124–5 embryo cryopreservation prevalence of, 22 critical appraisal, literature, 150–4 ethical dilemmas in, 141–4 socioeconomic burden and cross border reproductive services for fertility preservation, 117–20 psychosocial impact of, 27–8 (CBRS), 131–2, 133 for IVF, 75–6 symptoms and signs of, 26–7, 28 cryopreservation. See also embryo laboratory procedure for, 108–9 uterine abnormalities, 33, 40 cryopreservation; oocyte embryo culture endometriosis fertility index (EFI), 24 cryopreservation buffer use in, 95–6 endometrium, luteal phase support of, ethical dilemmas in, 141–4 gas phase of, 103–5 75 gonadal tissue, 115, 117–20 in incubators, 96, 103, 104 environment, laboratory, 93–4 laboratory procedure for, 108–9 laboratory procedure for, 103–5 epidemiology of infertility, 1, 2–3, 4 ovarian tissue, 117–20 media for, 88, 105 epididymis, 48 sperm, 117, 141–4 pH of, 103 equipment, validation and verification testicular tissue, 117 embryo glue, 88 of, 162 cryostorage, 93, 120 embryo screening, 146 ERA. See endometrial receptivity array cryptorchidism, 45 embryo selection erectile dysfunction (ED), 47 CTFR. See cohort total fertility rate conventional assessment for, 105–6, eSET. See elective single embryo culture. See embryo culture 107 transfer cystectomy, 29 laboratory procedure for, 105–6, 107 ESGE. See European Society of cystic fibrosis (CF), 46, 48, 50 time lapse imaging for, 106 Gynaecological Endoscopy embryo transfer ESHRE. See European Society of Danazol, 28 catheters for, 73 Human Reproduction and data protection, 165 cleavage stage or blastocyst transfer, Embryology density centrifugation, buoyant, 97–8 74 ethical dilemmas, 136, 137, 146 diabetes, 47–8 double, 108 baby design, 146 diagnostic laparoscopy. See in IVF, 59, 62–3, 73–4 comparison of adoptive parent laparoscopy laboratory procedure for, 105, 106–8 selection to fertility treatment diagnostic test accuracy studies, 150 number of embryos transferred in, access, 138–9 diet, 25–6 74, 106–8 confidentiality, 141 DNA tests, sperm, 90 technique of, 73–4 consequentialism approach to, 138 document control system, 160–1 ultrasound use in, 73 double jeopardy risks for patients donors. See also third-party endocrine disorders. See also with co-morbidities, 140–1 reproduction hypothalamic pituitary disorders; fairness approach to, 139–40 assessment of, 129–30 ovulation disorders in fertility preservation, 120–1

168

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in gamete cryopreservation, 141–4 patient assessment prior to, 116–17 for pituitary control in IVF, 70, 71 in gamete donation, 144–6 pregnancy outcomes in cancer gonadotropin-releasing hormone moral status of human embryos, 140 survivors, 120 analogues (GnRHa), 28, 29 in reproductive medicine versus preventative options for men, 121 gonadotropin-releasing hormone other branches of medicine, 136–7 preventative options for women, 121 (GnRH) antagonists rights-based system approaches storage options for men, 117 for fertility preservation, 118 to, 139 storage options for women, 117–20 OHSS prevention and, 77–8 welfare of potential people, 137–8, fertility rates, 1, 2–3 for pituitary control in IVF, 70–1 143, 145, 146 fertility sparing surgery, 121 gonadotropins ethical principles, 136, 137 fertility treatment access, 137–40 for endometrioma, 29 ethnicity, endometriosis risk and, 25 fibroids, uterine, 31–3, 38–9 for hypogonadotropic European Society of Gynaecological fimbrioplasty, 39 hypogonadism, 19–20 Endoscopy (ESGE), 33, 34 folic acid supplementation, 3–4, 7 mild ovarian hyperstimulation European Society of Human follicle flushing, 73 using, 56 Reproduction and Embryology follicle-stimulating hormone (FSH), OHSS prevention and, 77–8 (ESHRE), 33, 34 13, 49, 51 for ovarian stimulation in IVF, 71–2 European Tissues and Cells Directive for ovarian stimulation, 71–2 for ovulation induction in (EUTCD), 156 for ovarian stimulation in IVF, 71–2 PCOS, 17, 18 evidence replacement in males, 51 application of, 151–2 HA. See hyaluronic acid critical appraisal of quality of, gamete cryopreservation. See oocyte haematogenous spread, endometriosis, 150–2, 153 cryopreservation; sperm 23 overall quality of, 153–4 cryopreservation Halban’s theory of endometriosis, 23 evidence-based medicine (EBM), 147, gamete donation, 52, 79–80. See also hCG. See human chorionic 153 third-party reproduction gonadotrophin application of evidence, 151–2 donor selection for, 127–8 HFEA. See Human Fertilisation and clinical decision making with, 147 ethical dilemmas of, 144–6 Embryology Authority clinical practice guidelines, 153–4 as fertility preservation alternative, history and examination critical appraisal of literature, 150–4 122 female, 5, 6 literature searches, 148–50 for premature ovarian male, 5, 7, 47–8 structured questions, 147–8 insufficiency, 20 for tubal and uterine abnormalities, examination. See history and gamete intrafallopian 34, 35 examination transfer (GIFT), 79 hMG. See human menopausal exercise, 25–6 genetic tests. See also preimplantation gonadotrophin external review, 165 genetic testing hormone replacement therapy (HRT), for male infertility, 49–50 20, 51–2 fairness, in access to fertility treatment, GIFT. See gamete intrafallopian HPV vaccination, 3–4 139–40 transfer HRT. See hormone replacement therapy fecundability, 1, 3 glue, embryo, 88 HSG. See hysterosalpingography fecundity, 1 GM-CSF-containing culture media, HullandRutherfordclassification, 31, 32 female factor infertility. See also 87, 88 human chorionic gonadotropin (hCG) ovulation disorders; tubal GnRH. See gonadotropin-releasing for male infertility, 51–2 abnormalities/tubal factor hormone OHSS prevention and, 77–8 infertility; uterine abnormalities/ GnRHa. See gonadotropin-releasing for ovarian stimulation in IVF, 71, 72 uterine factor infertility hormone analogues ovulation triggered by, 69 fertility preservation options for, gonadal tissue cryopreservation, 115, Human Fertilisation and Embryology 117–20 117–20 Act, 120, 137–8, 140, 142, 143 further tests for, 10 gonadotoxicity, of cancer treatments, Human Fertilisation and Embryology history and examination for, 5, 6 113, 114 Authority (HFEA), 156, 164, preliminary investigations for, 7–8, 9 gonadotropin-releasing hormone 165 fertilisation (GnRH), 13, 45 adjunct definition of, 82 assessment of, 101–2, 103 congenital absence of, 19 adjuvants/add-on stance of, 83 laboratory procedures for failed, for hypogonadotropic Code of Practice of, 74, 80, 123, 102–3 hypogonadism, 19–20 124–5, 128–9 fertility preservation, 113 replacement in males, 51 counselling requirements of, 123, alternatives to, 122 gonadotrophin releasing hormone 124–5 ethical and legal issues in, 120–1 (GnRH) agonists patient support requirement of, 123, indications for, 113–14, 115 for fertility preservation, 118 124 mechanisms of cancer treatment OHSS prevention and, 77–8 role of, 80 damage and, 114–15 ovarian suppression with, 121 on welfare of children, 80 169

Index

human menopausal gonadotrophin oocyte retrieval for, 72–3 internet, in third-party reproduction, (hMG), 71 optimal timing of, 61–2 132, 133 human resources, 162–3 ovarian response monitoring intracytoplasmic morphologically hyaluronic acid (HA), 88 during, 72 selected sperm injection (IMSI), hyaluronidase, 99 ovarian stimulation for, 57, 59, 63, 89, 101–2 HyCoSy. See hysterosalpingo-contrast- 70–2 intracytoplasmic sperm injection sonography in PCOS, 17 (ICSI), 52–3 hydrosalpinx, 39, 41 pituitary control for, 70–1 assessment of fertilisation after, hyperprolactinaemia, 18–19, 49 poor response to, 72 101–2, 103 hypogonadotropic hypogonadism, reasons for failure of, 83 dish preparation for, 100 19–20, 45 risks of, 76–9 failed fertilisation in, 102–3 hypothalamic–pituitary disorders, 18 risks to children conceived IMSI compared with, 89, 101–2 female, 18–20 with, 79 indications for, 99 male, 45–6, 51–2 safety of, 59, 62–3, 76–9 laboratory procedure for, 99–102 hypothyroidism, 8, 9 sexual intercourse versus, 60–1 micromanipulation workstation for, hysterosalpingo-contrast-sonography success rates of, 76, 82 100 (HyCoSy), 10, 37 tubal surgery versus, 39–40 oocyte preparation for, 99 hysterosalpingography (HSG), 10, 36, for unexplained infertility, 56–7, PICSI compared with, 89–90, 101–2 58, 63 58–9, 60–3 procedure for, 100–1 hysteroscopy, 10, 37, 40, 41 incubators, embryo culture, 96, 103, rescue, 102–3 104 risks to children conceived with, 79 ICSI. See intracytoplasmic sperm induction theory of endometriosis, 22 techniques refining sperm selection injection infertility. See also specific causes for, 101–2 immunisation, 3–4, 7 cancer treatments causing, 46, 113, for unexplained infertility, 63 immunoglobulin therapy, 90–1 114–15 intralipids, 90–1 immunological processes, in confidentiality and, 141 intrauterine adhesions, 33–4, 35, 40, 41 endometriosis, 23–4 diagnosis of, 10–11 intrauterine insemination (IUI), 52, 68 immunomodulators, 90–1 epidemiology of, 1, 2–3, 4 complications of, 69 implantation, 75, 83 lifestyle advice for, 8–10 costs of, 59 implication discussion, 126, 127, prognosis of, 11, 54–6, 57, 63 cycle monitoring for, 69 130, 131 terms and definitions for, 1–3 effectiveness of, 58–9 IMSI. See intracytoplasmic unsuccessful treatment of, evidence for, 60, 61 morphologically selected sperm 136–7 indications for, 68–9 injection infertility assessment, 1, 11–12 IVF versus, 58–9 in vitro fertilisation (IVF), 70 advice for patients, 8–10 procedure for, 69 adverse obstetric and perinatal diagnosis, 10–11 safety of, 59, 69 outcomes of, 78–9 further tests, 10, 49–50, 51 sexual intercourse versus, 60, 61 assessment of fertilisation after, history and examination, 5, 6, 7, success rates of, 69 101–2, 103 47–8 for unexplained infertility, 56, 58–9, burden of, 59 infertility consultation, 5, 6, 7 60, 61, 63 costs of, 59, 83 preliminary investigations, 5–6, 7–8, intrauterine pathology, assessment of, decision to stop treatment with, 9, 48–9 10 80–1 primary care role in, 4–5 intravenous immunoglobulin, 90–1 ectopic pregnancy with, 78 prognosis, 11 IUI. See intrauterine insemination effectiveness of, 58–9 specialist centre role in, 5 IVF. See in vitro fertilisation embryo cryopreservation for, infertility counselling. See counselling 75–6 infliximab, 90–1 justice, in access to fertility treatment, embryo transfer for, 59, 62–3, 73–4 insemination. See also intrauterine 139–40 for endometrioma, 29 insemination evidence for, 60–3 conventional, 99 Kallmann syndrome, 19, 45 failed fertilisation in, 102–3 insemination in vitro,96–7. See also karyotyping, 49–50 future research and clinical practice intracytoplasmic sperm injection key performance indicators (KPIs), for, 63–4 chemical motility enhancers for, 161–2 gonadotropins for, 71–2 98–9 Klinefelter syndrome, 46, 47–8, IUI versus, 58–9 conventional, 99 49–50 laboratory procedures used in, 73 semen analysis for, 97 KPIs. See key performance indicators luteal phase support for, 75 sperm preparation for, 97–8 multiple pregnancy with, 59, sperm vitality tests for, 98 laboratory investigations 62–3, 78 insulin sensitising agents, for men, 5–6, 7, 10, 48–50, 51 OHSS with, 59, 70–1, 76–8 15–16 for women, 7–8, 9, 10

170

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laboratory procedures in assisted causes of, 45–7 obesity, 47–8, 58 reproduction, 93, 111–12 endocrine tests for, 49, 51 observational studies, 149–50 assessment of fertilisation, 101–2, fertility preservation options for, 117 oestradiol, 72 103 genetic tests for, 49–50 oestrogen replacement therapy, 20 buffer use in culture media for, 95–6 history and examination for, 5, 7, OHSS. See ovarian hyperstimulation conventional insemination, 99 47–8 syndrome cryopreservation, 108–9 medical treatment options for, 51–2 OI. See ovulation induction cryostore for, 93 post-testicular, 46–7 oocyte embryo culture, 103–5 pre-testicular, 45–6 artificial activation of, 89, 103 embryo selection, 105, 106, 107 prognosis of, 11 assessment of fertilisation of, 101–2, embryo transfer, 105, 106–8 radiological investigations for, 51 103 environment for, 93–4 reproductive tract and physiology, ICSI preparation of, 99 for failed fertilisation, 102–3 43, 44, 45 retrieval of, 72–3, 96 ICSI, 99–102 semen analysis for, 5–6, 7, 48–9 oocyte cryopreservation IVF procedures, 73 sperm function tests for, 10, 49, 50 ethical dilemmas in, 141–4 oocyte retrieval, 96 surgical treatment options for, 52 for fertility preservation, 117–20 PGT, 109–11 testicular, 46 laboratory procedure for, 108–9 semen analysis, 96–7, 98 media, culture, 88, 105 social or elective, 143–4 sperm preparation, 96–9 menstruation, 22, 24–5 oocyte donation, 79–80. See also sterile working areas for, 94–5 MESA. See microsurgical epididymal third-party reproduction witness of, 94 sperm aspiration procedure ethical dilemmas of, 144–6 laminar flow hoods, 94–5 meta-analysis, 148, 150–2, 153–4 as fertility preservation alternative, laparoscopic ovarian drilling (LOD), metaplastic transformation, in 122 16–17 endometriosis pathogenesis, 22 for premature ovarian insufficiency, laparoscopy metformin, 15–16, 83 20 for endometriosis diagnosis, 27 Meyer’s theory of endometriosis, 22 organisation of services, 156, 165 for endometriosis management, micromanipulation workstation, 100 clinical governance of, 163–5 28–9 microsurgical epididymal sperm data protection in, 165 pelvic, 10 aspiration procedure (MESA), 53 definitions of quality and success for, for tubal and uterine abnormality microTESE, 53 156–7 diagnosis, 37 mild ovarian hyperstimulation. See document control in, 160–1 leiomyomas, uterine, 31–3, 38–9 ovarian stimulation equipment and process validation letrozole, 16, 56, 118 moral status, of human embryos, 140 and verification in, 162 LH. See luteinising hormone motility enhancers, 98–9 key performance indicators for, libido disorders, 47 MRI. See magnetic resonance imaging 161–2 lifestyle multiple pregnancy process model use in, 157–8 advice for, 8–10 with clomiphene citrate use, 15 quality management practice in, endometriosis risk and, 25–6 with gonadotropins for ovulation 158–65 interventions for unexplained induction, 17 Quality Manager for, 159–60 infertility, 58 with IUI, 59, 69 quality objectives of, 158–9 male infertility and, 46 with IVF, 59, 62–3, 78 quality policy of, 158 likelihood ratio, 150 with mild ovarian hyperstimulation, quality review in, 165 literature 56 resource management in, 162–3 critical appraisal of, 150–4 number of embryos transferred and, structure of, 160 searches, 148–50 74 OTC. See ovarian tissue LOD. See laparoscopic ovarian drilling mumps orchitis, 46 cryopreservation long GnRH agonist protocol, 70 ovarian drilling, 16–17 luteal phase support, 75 National Institute for Clinical ovarian endometrioma, 24, 26, luteinising hormone (LH), 13, 69, 71 Excellence (NICE) 29, 36 lymphatic spread, in endometriosis, 23 embryo transfer guidelines of, 74 ovarian failure, 8, 20 fertility preservation guidelines of, ovarian hyperstimulation syndrome macroprolactin, 18–19 115–16 (OHSS) magnetic resonance imaging (MRI) IUI indications outlined by, 68–9 clinical features of, 76–7 for endometriosis diagnosis, 27 PCOS treatment guidelines of, during fertility preservation for male infertility, 51 14–15, 16, 18 protocols, 118 for tubal and uterine abnormality natural conception, 54–6, with gonadotropins, 17 diagnosis, 37 57, 63 with IUI, 59, 69 male factor infertility, 43, 53 negative predictive value, 150 with IVF, 59, 70–1, 76–8 assisted reproduction treatment NICE. See National Institute for management of, 78 options for, 52–3 Clinical Excellence prevention of, 77–8 171

Index

ovarian reserve, 8, 70, 72, PGT. See preimplantation genetic process model, organisation of services 114–15 testing use of, 157–8 ovarian shielding, 121 physical resources, 163 progesterone, 7–8, 75 ovarian stimulation. See also ovarian physiological intracytoplasmic sperm progestogens, 29 hyperstimulation syndrome injection (PICSI), 89, 101–2 prolactin (PRL), 18–19, 49. See also in fertility preservation, 118 PID. See pelvic inflammatory disease hyperprolactinaemia FSH dose for, 71–2 pituitary control prolactinoma, 18–19 gonadotropins for, 71–2 OHSS prevention and, 77–8 psychological assessment, 5 IUI with, 56, 57, 59, 63, 68–9 for ovarian stimulation, 70–1 psychosocial impact, of endometriosis, IVF with, 57, 59, 63, 70–2 pituitary disorders. See hypothalamic 27–8 pituitary control for, 70–1 pituitary disorders psychosocial support in third party poor response to, 72 POI. See premature ovarian reproduction, 123, 125, 132–4 response monitoring during, 72 insufficiency assessment of intended parents, ovarian suppression, 121 polycystic ovary syndrome (PCOS), 13, donors and surrogates, 129–30 ovarian tissue cryopreservation (OTC), 14 decision to use third party 117–20 aromatase inhibitors for ovulation conception, 126–7 ovarian transposition, 121 induction in, 16 donor, surrogate and partner ovulation, laboratory investigations of, clomiphene citrate for ovulation implication discussion and 7–8 induction in, 14–15 counselling, 130, 131 ovulation disorders, 20. See also gonadotrophins for ovulation in donor selection and relationship, polycystic ovary syndrome induction in, 17, 18 127–8 hypothalamic–pituitary disorders, insulin sensitising agents for HFEA counselling requirements 18–20 ovulation induction in, 15–16 and, 123, 124–5 premature ovarian insufficiency, 8, ovarian drilling for ovulation HFEA patient support requirements 20 induction in, 16–17 and, 123, 124 prognosis of, 11 polyps, endometrial, 33, 36, 37, 40 implication discussion, 126, 127, WHO classification of, 13 positive predictive value, 150 130, 131 ovulation induction (OI). See also post-coital test (PCT), 10 issues to address in, 126, 127 ovarian stimulation posthumous children/reproduction, patient needs in, 127 for hypogonadotropic 120–1, 141–3 after and beyond treatment, 128–9 hypogonadism, 19–20 prediction models for natural PTFR. See Period Total Fertility Rate for PCOS, 14–17, 18 conception public health responsibilities, 3–4 in evidence-based treatment parents algorithm for unexplained QM. See Quality Manager assessment of intended, 129–30 infertility, 63 quality assurance, 156, 157. See also ethical dilemmas involving donation history of, 54–5 quality management/quality recipients, 144–6 performance of, 55–6, 57 management system in surrogacy cases, 145 predictive values, 150 quality control, 157 patient counselling. See counselling pregnancy. See also multiple pregnancy quality improvement, 157, 162 patient support, 123, 124. See also after cancer treatment, 120 quality inspections, 164 psychosocial support in third ectopic, 78 quality management/quality party reproduction endometriosis risk and, 24–5 management system, 156, 157, 165 patient-centred care (PCC), 123 preimplantation genetic diagnosis clinical governance, 163–5 PCOS. See polycystic ovary syndrome (PGD), 109–10, 146 components of, 158, 159 PCT. See post-coital test preimplantation genetic screening data protection, 165 pelvic inflammatory disease (PID), 31 (PGS), 87, 109–10 document control in, 160–1 pelvic pain, 27, 29 preimplantation genetic testing (PGT) key performance indicators, 161–2 pelvic pathology, assessment of, 10 for aneuploidy, 87, 109–10 organisation of services practice of, pelvic ultrasound examination, 8 embryo biopsy for, 110–11 158–65 pentoxifylline, 98–9 laboratory procedure for, 109–11 organisational structure and, 160 percutaneous epididymal sperm premature ovarian insufficiency (POI), process model for, 157–8 aspiration (PESA), 53 8, 20 Quality Manager oversight of, 159–60 Period Total Fertility Rate (PTFR), 1 preservation, fertility. See fertility quality objectives, 158–9 peritoneal endometriosis, 24, 25, 26 preservation resource management, 162–3 PESA. See percutaneous epididymal prevalence of infertility, 3, 4 review of, 165 sperm aspiration primary care, infertility assessment in, validation and verification of PGD. See preimplantation genetic 4–5 equipment and processes, 162 diagnosis primary infertility, 3 Quality Manager (QM), 159–60 PGS. See preimplantation genetic PRL. See prolactin quality objectives, 158–9 screening process maps, 161 quality policy, 158

172

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quality review, 165 socioeconomic burden, of testis quality sampling, 164 endometriosis, 27–8 cancer treatment damage to, 46, 115 quality tours, 164–5 sodium bicarbonate buffer, 96 causes of infertility involving, 46 SOPs. See standard operating development of, 45 radiotherapy. See cancer treatment procedures examination of, 48 random start protocols, 118 specialist centres, infertility assessment physiology of, 43, 44, 45 randomised trials, 148–9, 151–2 in, 5 testosterone, 45 recombinant human FSH (rFSH), 71 specificity, diagnostic tests, 150 exogenous use of, 45–6 recombinant human LH (r-LH), 71 sperm. See also azoospermia measurement of, 49, 51 recurrent implantation failure (RIF), delivery of, 43, 46–7 replacement therapy, 51–2 83 motility enhancers for, 98–9 TFR. See Total Fertility Rate Remicade, 90–1 preparation of, 96–9 theophylline, 98–9 reproductive endocrine disorders, 13. production of, 115, 43, 44, 45 Third Party Agreements, 163 See also ovulation disorders retrieval of, 120 third-party reproduction, 123, 132–4. reproductive immunology procedures, surgical recovery of, 53 See also psychosocial support in 90, 91 sperm antibody testing, 51 third party reproduction rescue ICSI, 102–3 sperm cryopreservation, 117, 141–4 decision to use, 126–7 resource management, 162–3 sperm DNA tests, 90 ethical dilemmas of, 144–6 retained products of conception, 41 sperm donation, 52. See also third- global perspectives on, 131–2, 133 retrograde ejaculation, 47, 49 party reproduction HFEA Code of Practice in, 123, retrograde menstruation, 22 ethical dilemmas of, 144–6 124–5, 128–9 rFSH. See recombinant human FSH as fertility preservation alternative, HFEA counselling requirements in, RIF. See recurrent implantation failure 122 123, 124–5 rights-based systems of ethics, 139 sperm function tests, 10, 49, 50 HFEA patient support requirement risk management/risk assessment, in sperm vitality tests, 98 in, 123, 124 organisation of services, 164 spermatogenesis, 43, 46, 115 internet and medical developments r-LH. See recombinant human LH spinal cord injury (SCI), 46 impacting, 132, 133 Rotterdam criteria, 13–14 SSR. See surgical sperm retrieval thromboprophylaxis, for OHSS, 78 rubella immunisation, 3–4, 7 standard operating procedures (SOPs), thyroid function screening, 8, 9 160–1 thyroxine replacement therapy, 8, 9 salpingostomy, 39 Stein–Leventhal syndrome. See time-lapse imaging, 85–6, 106 Sampson’s theory of endometriosis, 22 polycystic ovary syndrome TNF-alpha blocking agents, 90–1 SCI. See spinal cord injury sterile working areas, 94–5 Total Fertility Rate (TFR), 1, 2–3 scrotal examination, 48 steroid therapy, 90–1 traceability, 163 secondary infertility, 3 STI. See sexually transmitted infection transgender men and women, 114 semen analysis, 5–6, 7, 48–9 storage. See cryostorage transvaginal ultrasonography (TVS) laboratory procedure for, 96–7, 98 structural uterine abnormalities, 33, 34 for endometriosis diagnosis, 27 sensitivity, diagnostic tests, 150 structured questions, 147–8 oocyte retrieval using, 72–3 septate uterus, 41 subfertility, 2 Trial on Intra-Uterine Insemination sequential media, 105 surgical sperm retrieval (SSR), 120 (TUI) Study, 60 Sertoli cells, 43, 45 surrogacy, 80 triple embryo transfer, 108 service delivery. See organisation of assessment for, 129–30 tubal abnormalities/tubal factor services ethical dilemmas of, 145–6 infertility, 31, 41 SETs. See single embryo transfers fertility preservation using, 121 assessment of, 10 sexual intercourse implication discussion and causes of, 31, 32 frequency of, 9–10 counselling for, 130, 131 diagnosis of, 34–8, 39 IUI or IVF for unexplained Surrogacy Arrangements Act, 145 history taking for, 34, 35 infertility versus, 60–1 swim-up technique, 97, 98 investigations for, 34–8, 39 sexually transmitted infection (STI), synthesis prediction model, 54–6, 57, prevention of, 41 3–4, 8, 31, 41, 46, 51 63 prognosis of, 11, 31 Sheehan’s syndrome, 19 systematic reviews, 148, 150–2, 153–4 treatment for, 38–41 short GnRH agonist protocol, 70, tubal flushing, 36, 58, 63 77–8 tamoxifen, 15, 118 tubal surgery, 39–40 single embryo transfers (SETs), 59, TESA. See testicular sperm aspiration TUI Study. See Trial on Intra-Uterine 62–3, 74, 108 TESE. See testicular sperm extraction Insemination Study single-step medium, 105 testicular biopsy, 51 TVS. See transvaginal ultrasonography slow freezing technique, testicular shielding, 121 108–9 testicular sperm aspiration (TESA), 53 UAGA. See Uniform Anatomical Gift smoking, 8, 10, 25–6, 46 testicular sperm extraction (TESE), 53 Act social egg freezing, 143–4 testicular tissue cryopreservation, 117 ultrashort protocol, 70 173

Index

ultrasound Uniform Anatomical Gift Act vasectomy, 46, 52 embryo transfer using, 73 (UAGA), 141–2 vasovasostomy, 52 for endometriosis diagnosis, 27 universal medium, 105 verification, of equipment and process, for intrauterine and tubal uterine abnormalities/uterine factor 162 pathology, 10 infertility, 31, 41 vitrification, 75–6, 108–9, IUI monitoring with, 69 adenomyosis, 33, 40 117–18 IVF monitoring with, 72 assessment of, 10 for male infertility, 51 conditions associated wash and spin, 98 oocyte retrieval using, 72–3 with, 31, 32 WHO. See World Health pelvic, 8 diagnosis of, 34–8, 39 Organization for tubal and uterine abnormalities, endometrial polyps, 33, 36, witness, of laboratory procedures, 35–6, 37, 38 37, 40 94 unexplained infertility, 54 endometriosis in, 33, 40 World Health Organization (WHO) comparative assessment of IUI fibroids, 31–3, 38–9 laboratory reference range versus IVF for, 58–9 history taking for, 34, 35 for semen characteristics, 6, 7, 49, evidence for IUI for, 60, 61 intrauterine adhesions, 33–4, 35, 98 evidence for IVF for, 60–3 40, 41 ovulation disorder classification of, evidence-based recommendations investigations for, 34–8, 39 13 for, 63 prevention of, 41 PCOS treatment guidelines of, first-line therapy of choice for, structural, 33, 34 15–16 58–9 treatment for, 38–41 on quality in organisation of future research and clinical practice services, 156–7 for, 63–4 vaccination, 3–4, 7 IUI treatment of, 56, 58–9, 60, 61, 63 validation Y microdeletions, 46, 50 IVF treatment of, 56–7, 58–9, 60–3 of equipment and process, 162 lifestyle interventions for, 58 of prediction models for natural ZIFT. See zygote intrafallopian prediction models for, 54–6, 57, 63 conception, 55–6 transfer sexual intercourse versus IUI or IVF validity, diagnostic tests, 150 zona pellucida, 86, 110 for, 60–1 varicocele, 46, 48, 52 zygote intrafallopian tubal flushing for, 58, 63 vasa deferens, 46, 48 transfer (ZIFT), 79

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