In Vitro Fertilization And Embryo Transfer

The new edition of this text admirably fills the need for a primer on the central topics involved in Human In Vitro Fertilization (IVF). Supplying a comprehensive and hands-on approach to IVF, this source presents established state-of-the-art procedures and techniques, as well as the most current research in the field. Expert contributors also discuss the history of IVF and the potential of future research. Offering essential information for reproductive endocrinologists, IVF practitioners and embryologists, this book guides readers though every step of human assisted conception, from patient pre-treatment to monitoring of outcomes.

The use of human in vitro fertilization in the management of infertility is the outgrowth of years of laboratory observations on in vitro sperm-egg interaction. "The editors of this work have themselves contributed significantly to basic knowledge of the mammalian fertilization process. The observations of Don Wolf on sperm penetration, the block to polyspermy and, most recently, sperm hyperactivation in the monkey and human, Gregory Kopf's elucidation of the mechanisms of sperm activation during penetration and the reciprocal dialogue between sperm and egg, and Barry Bavister's definition of culture conditions and requirements necessary for in vitro oocyte maturation, fertilization and development in model mammalian systems including nonhuman primates have contributed greatly to our understanding of the mammalian fertilization process. Wolf, Kopf and Gerrity have enjoyed substantial interaction with clinicians in Departments of Obstetrics and Gynecology and have been directly involved with successful IVF programs. Both Wolf and Kopf have served as research scientists in the Division of Reproductive Biology at the University of Pennsylvania, which, for more than 22 years, has fostered co-mingling of clinically oriented and basic science faculty. It is through such interaction, which clearly exists at many institutions including the University of Wisconsin, that the process of technology transfer is best served. Without an exquisitely coordinated laboratory, there can be no consistent success in human in vitro fertilization. Quality control is pivotal, but close collaboration between the laboratory and the clinic is also essential as information is shared and correlated.

In vitro fertilization and embryo transfer (IVF-ET) was the earliest of the assisted reproductive technologies. In Canada, it remains the most commonly practiced technique of assisted reproduction. IVF-ET is a technology which continues to evolve. IVF-ET has diffused widely without comprehensive assessment of its efficacy and safety. Most of the published reports concerning results with IVF-ET as a treatment of infertility have been based upon small, uncontrolled studies. Investigators have used different designs, treatment protocols, patient populations, sample sizes, definitions of outcome measures and types of outcome. Long-term, well-designed, prospective controlled clinical trials are required to determine when and for what indications IVF-ET is effective and what its long-term health effects are on both mothers and their babies. Reliable conclusions cannot be drawn on the effectiveness of IVF-ET for most indications. The available evidence supports the use of IVF-ET as a treatment of infertility related to damaged, occluded or absent Fallopian tubes. For other indications, the present evidence does not establish whether IVF-ET is more effective than receiving conventional treatment or no treatment at all. Obstetric and pediatric complications following IVF-ET may be significant.

The births of more than 100 apparently normal infants at term following pregnancies initiated by in vitro fertilization and embryo transfer testifies to the successful clinical application of insights obtained from studies in reproductive biology over the last 20 years. In women, these studies have included: 1) characterization of the changes in blood hormone profiles throughout ovulatory menstrual cycles; 2) documentation of the hormonal composition of antral fluid in developing and degenerating preovulatory follicles; 3) correlation of these observations with the state of oocyte maturation and the fertilizability of the oocyte; 4) application of pharmacologic agents for perturbing the normal hormone profiles to regulate the number of preovulatory follicles developing and the time of ovulation; and 5) development of non-invasi ve methods for monitoring follicular development. Optimizing methods for maturing and fertilizing eggs, for moni toring normal development in vi tro, and for transferring and achieving implantation of embryos are continuing concerns of physicians and scientists responsible for extant programs. In addition, all serious students of reproductive biology should critically examine every facet of the processes which must concatenate to assure birth of normal infants following pregnancies achieved by these methods. However, the literature which contains the informational substrate is dispersed widely in a plethora of journals not always readily accessible. Bringing the essentials together facilitates both rapid retrieval of data and access to relevant literature.