Controversial issues in assisted reproduction

- Frontmatter - Contents - List of contributors - Foreword by Bob Edwards - Preface - 1 Clinical assessment of the woman for assisted conception - 2 Clinical assessment and management of the infertile man - 3 Laboratory assessment of the infertile man - 4 Donor insemination - 5 Treatment options prior to IVF - 6 Strategies for superovulation for IVF - 7 Techniques for IVF - 8 Ovarian hyperstimulation syndrome - 9 Early pregnancy complications after assisted reproductive technology - 10 Oocyte donation - 11 Surrogacy - 12 Clinical aspects of preimplantation genetic diagnosis - 13 Controversial issues in assisted reproduction - 14 Alternatives to in vitro fertilization: gamete intrafallopian transfer and zygote intrafallopian transfer - 15 Counselling - 16 Good nursing practice in assisted conception - 17 Setting up an IVF unit - 18 Information technology aspects of assisted conception - 19 Assisted reproductive technology and older women - 20 Ethical aspects of controversies in assisted reproductive technology - Index - Plate section Published online by Cambridge University Press: 22 October 2009 Book contents - Frontmatter - Contents - List of contributors - Foreword by Bob Edwards - Preface - 1 Clinical assessment of the woman for assisted conception - 2 Clinical assessment and management of the infertile man - 3 Laboratory assessment of the infertile man - 4 Donor insemination - 5 Treatment options prior to IVF - 6 Strategies for superovulation for IVF - 7 Techniques for IVF - 8 Ovarian hyperstimulation syndrome - 9 Early pregnancy complications after assisted reproductive technology - 10 Oocyte donation - 11 Surrogacy - 12 Clinical aspects of preimplantation genetic diagnosis - 13 Controversial issues in assisted reproduction - 14 Alternatives to in vitro fertilization: gamete intrafallopian transfer and zygote intrafallopian transfer - 15 Counselling - 16 Good nursing practice in assisted conception - 17 Setting up an IVF unit - 18 Information technology aspects of assisted conception - 19 Assisted reproductive technology and older women - 20 Ethical aspects of controversies in assisted reproductive technology - Index - Plate section Fibroids: remove, leave or embolize? Fibroids are a frequent finding in women with infertility (Figure 13.1). Many clinicians who have performed myomectomy on infertile women have reported that the treatment is effective and increases the pregnancy rate. However, no randomized controlled trials have been performed to establish the causal relationship. In a review of the literature, Vercellini et al. (1992) concluded that fibroids do not cause infertility in the vast majority of cases. Effective management of the woman with fibroids who wishes to conceive cannot yet be determined by an evidence-based approach using randomized controlled trials. However, it is clear that subfertility resulting from fibroids is not absolute and many women will conceive without intervention. It is sensible to ensure that other causes of infertility have been looked for and if present, treated appropriately in the absence of other causes of infertility. The couple is advised to try for at least two years to conceive naturally, unless the woman is aged 34 years or more, when more rapid intervention becomes advisable, given the negative impact of increasing female age on the likelihood of pregnancy, both naturally and after IVF and embryo transfer (IVF-ET). Many women with fibroids have favourable obstetric outcomes but it is well accepted that the presence of myomas increases the risk of pregnancy related problems. Pregnant women with fibroids have an increased chance of developing pain, red degeneration, bleeding, premature labour, fetal malpresentation, need for operative delivery, retained placenta and postpartum haemorrhage. In a combined series of 1284 women with fibroids, 13% of pregnancies were complicated by premature labour (Rice et al., 1989). Fibroids are classified according to site (Figure 13.2). - Type - Chapter - Information - Good Clinical Practice in Assisted Reproduction , pp. 226 - 255Publisher: Cambridge University PressPrint publication year: 2004 Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. 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