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21 results

Page 1 of 2

  • Chapter 21 - Is in vitro maturation the best approach?

  • from Section 3 - Stimulation
  • Edited by Gab Kovacs, Monash University, Victoria
  • Book:
    How to Improve your ART Success Rates
    Published online:
    05 July 2011
    Print publication:
    30 June 2011, pp 115-119

  • Summary

    In vitro maturation (IVM), a technique which has the potential to provide the pregnancy rates of conventional in vitro fertilization (IVF) in selected cases while avoiding the risks and costs associated with controlled ovarian hyperstimulation (COH), could be considered a better option. It is not only a recognized treatment alternative for couples who need assisted reproduction technology (ART), but also is considered as an innovative fertility preservation method which extends the options for patients with various diseases that preclude treatment with conventional methods. Young women with high antral-follicle counts achieve the highest pregnancy rates with IVM. Such women also have a high risk of ovarian hyperstimulation syndrome (OHSS) following COH. IVM expands the fertility preservation options for women who are not candidates for IVF and embryo cryopreservation (EC) for various reasons. Women with hormonesensitive tumors may undergo immature oocyte collection and cryopreserve resultant embryos.

  • Chapter 36 - Clinical potential of in vitro maturation

  • from Section 8 - In vitro follicle growth and maturation
  • Edited by Jacques Donnez, Université Catholique de Louvain, Belgium, S. Samuel Kim, University of Kansas
  • Book:
    Principles and Practice of Fertility Preservation
    Published online:
    04 February 2011
    Print publication:
    03 February 2011, pp 431-439

  • Summary

    Ovarian cryopreservation presents a valid alternative to egg freezing in some circumstances. The possibility to store oocytes for a later use is also an important consideration for women who choose to postpone motherhood for personal or professional reasons. Any newly developed protocol should consider the biochemical and physical properties of the oocyte. In addition to surviving the cryopreservation/warming process, the oocyte needs to maintain competence to fertilize and develop in vitro to the appropriate embryonic stage without any structural alterations. Slow cooling protocol is characterized by a slow decreasing temperature rate. Several mathematical models define an optimal curve applicable to oocytes since the freezing rate is vital to achieve sufficient and progressive dehydration, and thereby minimize the potential of intracellular ice formation. During fresh cycles only a few oocytes can be inseminated; therefore, cryopreservation is the only option to avoid wastage of surplus eggs and consequent repeated ovarian stimulation.

  • Chapter 17 - In vitro maturation of oocytes

  • from Section 5: - Alternatives to ovarian hyperstimulation
  • Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
  • Book:
    Ovarian Stimulation
    Published online:
    05 August 2011
    Print publication:
    23 December 2010, pp 181-194

  • Summary

    Management of the poor responder remains one of the greatest challenges of controlled ovarian hyperstimulation (COH) in preparation for the assisted reproductive technologies. This chapter reviews a variety of approaches which have been employed in this poorly defined patient group. The profound suppression of gonadotropins induced by traditional long luteal gonadotropin-releasing hormone agonist (GnRHa) protocols may be particularly devastating for poor responders. Decreasing the GnRHa dose during the luteal phase prior to COH would theoretically decrease the extent of endogenous gonadotropin suppression while preventing premature ovulation. The administration of estradiol in the luteal phase may induce follicle-stimulating hormone (FSH) receptor formation in more resistant follicles and result in a more coordinated gonadotropin response. The ability to enhance endogenous follicular phase gonadotropin release by the administration of either clomiphene citrate or an aromatase inhibitor would represent an attractive adjunct to GnRHant protocols in poor-responder patients.

  • Chapter 12 - In vitro maturation

  • Edited by Gab Kovacs
  • Book:
    The Subfertility Handbook
    Published online:
    06 December 2010
    Print publication:
    11 November 2010, pp 135-147

  • Summary

    Male reproductive dysfunction is the sole or contributory cause in half of infertile couples. Some health issues are more prevalent in infertile men and must be sought and the opportunity taken to assess and improve general and sexual health. Spontaneous conception may occur in many couples with male factor subfertility. In counseling patients, the severity of the male's reproductive problem, the duration of unprotected intercourse, and its frequency and timing, and the female partner's age and reproductive status are all important variables. There is a substantial background rate of spontaneous conception in subfertile men such that about 30% of couples with sperm densities of 1-5 million/ml as the only apparent fertility issue, achieved pregnancy over a two- to three-year period. Depending on the couple's age and reproductive history, some couples are happy to delay treatment in the hope that they will conceive while others express a wish for immediate intervention.

The Fallopian Tube in Infertility and IVF Practice
  • Edited by William L. Ledger, Seang Lin Tan, Adil O. S. Bahathiq
  • Published online:
    06 July 2010
    Print publication:
    29 March 2010
  • The Fallopian tube has until recently been a neglected structure, bypassed by IVF and seen only as a tube that transports the egg to the uterus. More recently, its central role as the site of fertilization and early embryogenesis has been recognized, along with the major effects of tubal disease, such as chlamydia trachomatis, on fertility. Tubal surgery is an option for those women who avoid IVF because of anxiety about medication side-effects or for religious reasons. The tube is also the site for female sterilization and its reversal. This definitive guide to the Fallopian tube and its disorders collates all these topics, with authoritative text covering the spectrum of clinically relevant topics in a digestible fashion. It will be of interest to gynecologists, specialists in reproductive medicine and infertility and family planning, and others with interest in this fascinating and underestimated organ of reproduction.

  • 17 - Vitrification of human oocytes using the McGill Cryoleaf protocol

  • from Section 4 - Cryopreservation of oocytes
  • Edited by Ri-Cheng Chian, McGill University, Montréal, Patrick Quinn
  • Book:
    Fertility Cryopreservation
    Published online:
    06 July 2010
    Print publication:
    13 May 2010, pp 144-156

  • Summary

    Advances in assisted reproductive technology (ART) have created opportunities for preservation of the reproductive potential of young males with cancer. Semen cryopreservation is possible in most adolescents with cancer regardless of age or diagnosis. Awareness by physicians is even more essential when dealing with younger populations. Theoretically, testicular tissue from prepubertal boys facing gonadotoxic treatment could be banked for many years for spermatogonial stem cell transplantation. Male germline stem cells are the only cells in postnatal mammals that undergo self-renewal and transmit genes to subsequent generations, since all female germline stem cells cease their proliferation before birth. Future possible methods of restoring fertility might include the derivation of mature sperm cells from human embryonic stem cells. Embryoid bodies were shown to support maturation of the primordial germ cells into haploid male gametes, which when injected into oocytes round off the somatic diploid chromosome complement and develop into blastocysts.

  • 49 - In Vitro Maturation of Human Oocytes

  • from PART III - ASSISTED REPRODUCTION
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 448-455

  • Summary

    This chapter discusses the process of in vitro maturation (IVM) of human oocytes. Oocyte maturation in vitro is profoundly affected by culture conditions. Different media have been used for in vitro oocyte maturation. The presence of estradiol in the culture medium of immature oocytes has no effect on the progression of meiosis, but improves fertilization and cleavage rates. Oocyte retrieval in IVM cycles is also largely performed in the follicular phase in routine practice. Immature human oocytes can be recovered from the ovaries during both the follicular and luteal phase. Polycystic ovary syndrome (PCOS) patients having the highest risk of ovarian hyperstimulation syndrome (OHSS), and the best chance for pregnancy due to a higher antral follicle count (AFC) have been the most appropriate candidates for routine IVM treatment. Luteal support is started on the day that maturation is achieved and intracytoplasmic sperm injection (ICSI) is performed.

  • 14 - Novel treatments for polycystic ovary syndrome, including in vitro maturation

  • Edited by Gabor T. Kovacs, Monash University, Victoria, Robert Norman, University of Adelaide
  • Book:
    Polycystic Ovary Syndrome
    Published online:
    29 September 2009
    Print publication:
    22 February 2007, pp 215-232

  • Summary

    Introduction

    Polycystic ovary syndrome (PCOS) was first described by Stein and Leventhal (1935), although the overweight, hirsuit, amenorrheic phenotype they originally described, we now realize, probably reflects the severe end of the spectrum of the syndrome. Diagnosis is made primarily by ultrasound and endocrine changes, although there remains some controversy about the significance of ultrasound-only diagnosed PCOS when the clinical phenotype and endocrine pattern are normal (Polson et al. 1988, Abdel Gadir et al. 1992). The ultrasound features of PCOS are enlarged ovaries, thickened ovarian stroma, multiple peripheral cysts (2 –10 mm diameter), and an increased intraovarian stromal blood flow (Adams et al. 1986, Zaidi et al. 1995, Buckett et al. 1999). The endocrine pattern is characterized by raised serum luteinizing hormone (LH) levels in the early follicular phase or raised ratio of LH to follicle stimulating hormone (FSH) and raised levels of testosterone and androstenedione, often associated with reduced levels of sex hormone binding globulin (SHBG) (Hull 1987, DeVane et al. 1975). However, not all these features are present in every case of PCOS and it is clear that the syndrome, primarily anovulation associated with hyperandrogenemia, is an end-point of multiple causes and this is reflected in the unknown etiology of the syndrome.

    This heterogeneity has spawned many avenues for treatment of PCOS such as weight loss and lifestyle management, ovulation induction with varieties of agents, the treatment of hyperinsulinemia, the treatment of hyperandrogenemia, and the surgical treatment of PCOS. All these are described elsewhere in this volume.

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