Clinical Management of Infertility: Problems and Solutions (Reproductive Medicine for Clinicians Book 2)

This new volume in the Reproductive Medicine for Clinicians series focuses on the practical clinical impact of problems linked to infertility, discussing topics such as luteal support in ART cycles, ovulation induction using pulsatile administration of GnRH, how to deal with the metabolic changes in PCOS, treatment to restore fertility in endometriosis and how to improve implantation, which are common aspects of daily clinical practice. It also addresses significant novel areas like the biological clock in human reproduction, reproduction at advanced parental age and medical and social egg freezing, offering valuable insights for patients and their doctors. Further, the book covers various areas of growing importance, such as how to access the uterine cavity; the future of imaging in reproduction; non-invasive prenatal testing; ART and male infertility; as well as breast cancer and fertility preservation. Last but not least, it examines the medical, ethical and legal aspects of a number of challenges for current and future reproductive medicine, including uterine transplantation and human genetic modification. Bringing together updates on some of the most important problems in reproductive medicine and also covering ethical and legal bases, this book offers an overview of potential treatments for infertility. As such, it is a valuable resource for gynecologists, obstetricians, endocrinologists and all specialists dealing with reproductive health. Foreword Preface Contents Part I: Ethical Issues in Human Reproduction Human Reproduction: Religious Perspectives Introduction The Jewish Law: Halakha Jews Law and Infertility Christianity Roman Catholic Church Eastern Orthodox Church The Protestant Church Anglican Church Islam Reproduction in Islam Embryo Research Hinduism Buddhism References Ethics in Clinical and Imaging Practice in Reproductive Medicine Introduction Need for Timely Referral Ethical Issues in Ultrasound Imaging Practice Uterine and Cervical Assessment Fallopian Tube Ovaries and Cul-de-Sac Ethical Issues in Clinical Practice Oocyte and Embryo Donation and Surrogacy Preimplantation Genetic Analysis (PGA) Conclusions References Reproduction at Advanced Parental Age Reproduction at Advanced Parental Age Reproduction at Advanced Maternal Age Pregestational Considerations Gestational and Obstetrical Considerations Maternal Mortality The Neonate Donor Egg-Based Fertility Treatments Advanced Paternal Age Definition and Incidence of APA Fertility and Sperm Parameters at APA The Genetic Risks of Advanced Paternal Age De Novo Autosomal Dominant Mutations Chromosomal Abnormalities Other Genetic Risks Congenital Anomalies Childhood Cancers Neurodevelopmental Outcomes Schizophrenia Autism Spectrum Disorders (ASDs) Other Psychiatric Disorders and Neurodevelopmental Outcomes Obstetrical Complications Associated with APA Ethical Considerations The Issue of Choice The Welfare of the Child The Law and Religion Summary and Conclusions References Cross-Border Reproductive Care: Current State of the Art Introduction Global Perspective on Cross-Border Reproductive Care In Vitro Fertilization Oocyte Donation Embryo Donation Sperm Donation Preimplantation Genetic Testing Surrogacy Surrogacy Around the World Traditional vs. Gestational Surrogacy Multiple Embryo Transfers and Abortions Summary References Uterine Transplantation Introduction Human Uterine Transplantation Experience of the Swedish Team Technical Modifications Discussion References Part II: Clinical Challenges: Patients and Therapies Pediatric and Adolescent Gynecology Physiology and Pathology Introduction Anatomy and Physiology Pathologic Conditions in Pediatric and Adolescent Gynecology Prepubertal Child Vulvovaginitis Labial Adhesion Lichen Sclerosus Ovarian Torsion Abnormalities of Puberty Precocious Puberty Delayed Puberty Congenital Anomalies of Female Genital Tract Gonadal Dysgenesis Menstrual Disorders Heavy Menstrual Bleeding (HMB) of Puberty Polycystic Ovary Syndrome (PCOS) in Adolescents Dysmenorrhea and Endometriosis References Biological Clock in Human Reproduction Biological Clock and the Physiology of the Ovulatory Cycle Molecular Basis of the Clock Genes Pineal and Extrapineal Melatonin Activity Biological Clock and Aging of Female Reproductive System Biological Clock and Aging of the Male Reproductive System Conclusions References Ovulation Induction by Pulsatile Administration of GnRH: State of the Art Physiology of Pulsatile GnRH Administration Administration of Pulsatile GnRH in the Human Intravenous Administration Subcutaneous Administration Pulsatile GnRH Administration in Hyperprolactinemia Pulsatile GnRH Administration in Hyperandrogenic Ovarian Insufficiency Alternatives to GnRH Acting at the Hypothalamic Level Naltrexone Kisspeptides: An Alternative? Conclusion References Pathogenesis of PCOS: From Metabolic and Neuroendocrine Implications to the Choice of the Therapeutic Strategy Introduction Physiopathology of the PCOS Patients Weight and Metabolism Hyperandrogenism Insulin Resistance New Perspectives in the Pathogenesis of PCOS Genetics, Metabolism, and PCOS The Management of Infertility in PCOS Patients Lifestyle Modification Bariatric Surgery Metformin Clomiphene Citrate Letrozole Ovarian Drilling Gonadotropins and IVF Inositols Alpha-Lipoic Acid Conclusions References Mysteries of the Uterine Cavity Background Techniques and Patients Vaginal Ultrasound, Saline Infusion Sonohysterography, and Hysterosalpingo-Contrast Sonography Diagnostic Hysteroscopy, Mini-hysteroscopy, or Office Hysteroscopy Operative Hysteroscopy [5, 6] Our Experience Discussion, Future Perspectives, and Conclusion References Endometriosis: Therapeutic Approach Combined Therapy with Estrogens and Progestogens Progestogens Medroxyprogesterone Acetate Megestrol Acetate Norethisterone Acetate (NETA) Dydrogesterone Dienogest Levonorgestrel-Releasing Intrauterine Therapeutic System Antigonadotropins Gonadotropin-Releasing Hormone Agonists Nonsteroidal Anti-inflammatory Drugs Vitamin D Surgical Treatment of Endometriosis Chronic Pelvic Pain Endometrioid Ovarian Cysts Endometriosis-Associated Infertility Conclusion References ART and Male Infertility Introduction Evaluation of the Infertile Male Treatment and Clinical Approach ART for Male Factor Infertility Intrauterine Insemination (IUI) for Male Factor Infertility IVF or ICSI for Male Factor Infertility Obstructive Azoospermia and ART Nonobstructive Azoospermia and ART Sperm Selection Techniques Outcomes Following ICSI Challenges and Future Research Priorities Conclusion References Laparoscopy and Gynecological Cancers Introduction General Development of Endoscopic Surgery in the Treatment for Gynecological Malignancies Tissue Morcellation and the Sarcoma Thread for Endometrial Adenocarcinoma and Leiomyosarcoma Endometrial Adenocarcinoma Leiomyosarcoma Contained Morcellation: Does It Diminish the Risk? How Are We Supposed to Handle Tissue Extraction Today? Cervical Cancer Developments of Cervical Cancer Surgery: Open, Conventional Laparoscopic, and Robotically Assisted Laparoscopic Safety, Surgical Results, Recurrence, and Survival Rates Does Minimally Invasive Radical Hysterectomy in Cervical Cancer Treatment Come to a Halt Now? Ovarian Cancer Facts and Reality Stage II Cancers Stage III Cancers Stage IV Cancers Role of Laparoscopy in Diagnosing Extensiveness of Ovarian Cancer Discussion, Conclusions, and Vision for All Three Discussed Gynecological Cancer Treatments References Part III: Fertility Preservation and Cryopreservation Breast Cancer and Fertility Preservation Introduction Gonadotoxic Effects of Anticancer Therapy Options for Fertility Preservation Assisted Reproduction Technologies (ART) Cryopreservation of Unfertilized and/or Fertilized Oocytes and Embryos Ovarian Stimulation Risks of Ovarian Stimulation and Follicle Puncture Medical Protection of the Gonads: GnRHa Cotreatment Fertility Preservation by Surgery Ovarian Tissue Ovarian Transposition Combined Techniques of Fertility Preservations Conclusion References Fertility Preservation Using Cryopreserved-Stored Ovarian Tissue: Where Are We Today? Introduction Success Rates Ovarian Follicle Loss in OTCP-AT Prevention of PMF Loss in Transplanted Grafts Transplantation Site Graft Dimensions Safety The Future Conclusions References Elective Oocyte Cryopreservation Introduction Ovarian Stimulation and Oocyte Vitrification Safety and Risks Clinical Outcomes Ethical Considerations Current Guidelines Our Own Experience Conclusions References Medical and Elective (Social) Egg Freezing: Key Insights from Women’s Perspectives Introduction Medical Egg Freezing (MEF) Elective Egg Freezing (EEF) Conclusion References Part IV: Prenatal Testing Noninvasive Prenatal Testing (NIPT): Past, Present, and Future History Current Applications and Limitations Future References Kurjak Antenatal Neurodevelopmental Test (KANET): A Useful Tool for Fetal Neurodevelopmental Assessment Introduction About the KANET How to Perform KANET? The Results of KANET from the Multicentric Studies Short Description of Recent Studies on KANET Discussion Are There Any Obstacles for the Use of KANET? Conclusion References Part V: Recurrent Implantation Failure and Pregnancy Loss Recurrent Implantation Failure Introduction Maternal Factors Uterine Anatomy Thrombophilia Infection Immunological Factors The Endometrium The Embryo Genetics Embryonic Factors Paternal Factor Low Sperm Quality Conclusion References Recurrent Pregnancy Loss Introduction Prognosis Assessment of RPL Problems with the Evidence-Based Approach Confounding Factors The Question Asked of a Meta-Analysis Diagnosis Genetic Aberrations Parental Genetic Aberrations Biomarkers Maternal Causes of RPL Uterine Anomalies Antiphospholipid Syndrome (APS) The Refractory Patient Hereditary Thrombophilias Alloimmune Pregnancy Loss Intravenous Immunoglobulin Intralipid Filgrastim Empirical Treatment Regimens Hormone Supplementation Progestogens Human Chorionic Gonadotropin (hCG) Empirical Anticoagulants Heparins Aspirin Assisted Reproductive Technology (ART) Pregestational Testing for Aneuploidy (PGT-A) Gamete Donation Gestational Carrier Surrogacy Late Pregnancy Losses References