Office-Based Infertility Practice

The practice of clinical reproductive medicine has practice in the era of managed care and coordinat­ gradually moved from its initial 1980-90 hospital ing ancillary offsite medical personnel. base to its present (circa 2001) office site of oper­ The objective of this text is to assist in this ongo­ ation. With this transition have been improvements ing endeavor by presenting in a clear, concise man­ in efficiency of practice often in response to ner many of the topics relevant to contemporary increased pressure to provide the most patient sat­ office-based infertility practice. The initial half of isfaction. An added challenge of office-based prac­ this text addresses topics which focus upon general tice has been taking on many of the responsibili­ concepts of infertility evaluation and practice. The ties of what had been traditionally the hospital's latter half is a practical approach to the execution domain. Some of these new responsibilities have of specific office-based infertility procedures. We included the ordering of operative supplies and hope this book will assist all medical personnel who equipment, the establishment of quality control dedicate their clinical effort in achieving what is programs, construction and maintenance of special most coveted by our patients, the birth of a healthy laboratory spaces, redesigning efficient methods of newborn. DAVID B. SEIFER, M. D. UMDNJ-Robert Wood Johnson Medical School ROBERT L. COLLINS, M. D. The Reproductive Center, Youngstown, Ohio October 2001 vii Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii . . . . . . . . . . . . . . . . . Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi . . . . . . . . . . . . . . . . . 1 Evaluation of the Female for Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Bryan D. "Office-Based Infertility Practice" is an invaluable resource to all physicians treating infertile couples. The text emphasizes the practice of infertility in the office setting, reflecting the current trend away from the hospital into the outpatient environment. The most current and advanced therapies available are discussed by recognized experts in the field.

The first half of the book is devoted to the evaluation and work-up of the infertile couple, including evaluation of the male, female, age-related infertility factors, and the roles of ultrasound, endometrium saline sonography, falloposcopy and diagnostic laparoscopy and hysteroscopy. The second half of the book presents the treatment and operative procedures for the infertile couple, including ovulation induction, IUI, tubal cannulation, treatment of cervical stenosis, the use of office laparoscopy and therapeutic hysteroscopy, male treatment as support for IVF, vas reversals, and testicular biopsy, as well as routine IVF, intratubal gamete transfer, and micromanipulation. With over 60 illustrations, this book is a must for all infertility specialists, obstetrician-gynecologists, fellows, and residents. Its practical, comprehensive approach will be of daily use to the office practitioner treating women of reproductive age.

David B. Seifer, M.D., is a tenured Professor of Obstetrics and Gynecology and Reproductive Sciences at UMDNJ-Robert Wood Johnson Medical School and the Director of the Division of Reproductive Endocrinology and Infertility. He completed his residency at Stanford University Medical Center and a fellowship at Yale University School of Medicine. Dr. Seifer is Board Certified in Obstetrics and Gynecology with Subspecialty Certification in Reproductive Endocrinology and Infertility. He has received career development awards from the American Society of Reproductive Medicine and the National Institutes of Health (NIH). He is a member of the Ostetrics and Gynecology Medical Devices Panel of the Food and Drug Administration. Dr. Seifer is funded by the NIH for research pertaining to the female reproductive aging.

Robert L. Collins, M.D., Board Certified in Reproductive Endocrinology, received his M.D. from the University of Tennessee. He completed his residency training in Obstetrics and Gynecology at the Tripler Army Medical Center in Honolulu. He received the National Fellowship in Reproductive Medicine from the National Institutes of Health in Bethesda, Maryland. Dr. Collins is currently Director, Section of Reproductive Medicine at St. Elizabeth Medical Center in Youngstown, Ohio, and an Associate Professor in the Department of Obstetrics and Gynecology at Northeast Ohio University College of Medicine in Rootstown, Ohio.

This book emphasizes the practice of infertility in the office setting, reflecting the current trend away from the hopsital into the outpatient environment. The first section is devoted to the diagnostic testing and work-up of the infertile couple; the second section presents the gamut of treatment options and operative procedures for the infertile couple. This new book includes the most current and advanced therapies available as discussed by recognized experts in the field. It is an invaluable resource for all physicians treating infertile couples.

Office Infertility: Practice and Procedures is an invaluable resource to all physicians treating infertile couples. The text emphasizes the practice of infertility in the office setting, reflecting the current trend away from the hospital into the outpatient environment. The most current and advanced therapies available are discussed by recognized experts in the field. The first half of the book is devoted to the evaluation and work-up of the infertile couple, including evaluation of the male, female, age- related infertility factors, and the roles of ultrasound, endometrium saline sonography, falloposcopy and diagnostic laparoscopy and hysteroscopy. The second half of the book presents the treatment and operative procedures for the infertile couple, including ovulation induction, IUI, tubal cannulation, treatment of cervical stenosis, the use of office laparoscopy and therapeutic hysteroscopy, male treatment as support for IVF, vas reversals, and testicular biopsy, as well as routine IVF, intratubal gamete transfer, and micromanipulation. With 200 illustrations, including 12 in full color, this book is a must for all infertility specialists, obstetrician-gynecologists, fellows, and residents. Its practical, comprehensive approach will be of daily use to the office practitioner treating women of reproductive age Front Matter....Pages i-xii Evaluation of the Female for Infertility....Pages 1-9 Evaluation of the Male for Infertility....Pages 10-23 Detection and Therapeutic Approaches to Age-Related Infertility....Pages 24-38 Role of Ultrasonography in Infertility....Pages 39-48 Coping with Infertility: Practical Psychosocial Issues....Pages 49-57 Impact of Managed Care on Office-Based Infertility Practice....Pages 58-62 Basics of Laboratory Setup in the Office....Pages 63-76 Anesthesia in the Office....Pages 77-99 Ovulation Induction and Controlled Ovarian Hyperstimulation with Intrauterine Insemination....Pages 100-115 Diagnostic and Therapeutic Hysteroscopy in the Office....Pages 116-126 Endoscopic Evaluation of the Fallopian Tube....Pages 127-136 Transcervical Tubal Cannulation....Pages 137-140 Microlaparoscopy for Infertility in the Office....Pages 141-146 Treatment of Cervical Stenosis....Pages 147-149 Treatment of Male Reproductive Dysfunction in the Office....Pages 150-160 In Vitro Fertilization in the Office Setting....Pages 161-173 Unstimulated In Vitro Fertilization and In Vitro Oocyte Maturation....Pages 174-183 Intratubal Gamete Transfer....Pages 184-194 Complications of Ovulation Induction....Pages 195-202 Back Matter....Pages 203-211