The Infertility Manual Kamini A Rao, Howard Carp
INDEX
A
Abnormal sperm parameters 179
Acrosome reaction 158
Adenomyosis 34, 221
Adoption 22, 481
Adult stem cell 620
properties 620
Advanced diagnostic procedures 7
Alternatives of ART 466
indication 466
follicular monitoring and hCG administration 467
oocyte aspiration 467
ovarian stimulation 467
sperm preparation 467
Alternatives to IUI 468
direct intrafollicular insemination (DIFI) 468
direct intraperitoneal insemination (DIPI) 468
fallopian tube sperm perfusion 469
intrafallopian insemination 469
Alternatives to IVF 469
direct oocyte transfer 470
follicular aspiration sperm injection and assisted rupture 470
gamete intrafallopian transfer 471
intravaginal culture 471
peritoneal oocyte sperm transfer 469
Amenorrhea 129
primary 129
clinical evaluation 129
Anejaculation 191
Anorexia nervosa 132
acceptance criteria 490
counseling 490
evaluation of oocyte recipients 459
evaluation of the partner of the oocyte recipient 459
pregnancies in oocyte recipient 462
procedure 455
screening and testing of oocyte donors 460
screening tests for donor 490
screening tests for recipients 490
selection of the donor 459
success of oocyte donation 460
Antagonist regimen 371
Anti-mullerian hormone 114
Antiprogesterone 12
Antisperm antibodies 70
Antisperm antibody latex agglutination test 72
Applebaum's USSR scoring system 38
Arcuate uterus 223
Aromatase inhibitors 421
Asherman's syndrome 34, 133
Assisted hatching 449
Assisted reproductive technologies 118, 521
culture for maturation of immature oocytes 522
identification and culture of immature oocytes 525
IVM for oocyte donors 522
IVM in partially stimulated ovaries 524
method of collection of immature oocytes 523
Autosomal anomalies 151
inversions 151
reciprocal translocations 151
robertsonian translocations 151
Azoospermia 180
B
Bicornuate uterus 222
Blastocyst 449, 547
Body mass index 136
C
Centrifugation and washing 558
Cervical factors in infertility 213
cervical changes during the menstrual cycle 218
cervical mucus scoring 214
etiology 213
investigation 214
postcoital test 215
abnormal postcoital test 215
clinical significance 215
procedure 215
timing 215
postcoital test 218
role of the cervix in reproduction 213
tests for sperm-mucus interaction 217
fractional postcoital test 217
in vitro sperm penetration test 217
mucus penetration test 217
treatment 218
Chlamydia infection 60
diagnosis 61
impact on fertility 61
treatment 62
Cleavage 544
Clomiphene citrate 79, 115, 402, 421
Cold penis 188
Collection of sperm 558
Composition of culture media 515
amino acids 516
ammonium 516
antibiotics 517
antioxidants 517
buffer system 518
chelators 516
growth factors 517
ions 515
osmolarity 518
protein/macromolecules 517
vitamins 516
water 515
Computer-assisted semen analysis 176
Congenital anomalies 33
Congenital uterine anomalies 221
Conservative surgery 23
Controlled ovarian stimulation 420, 443
antiphospholipid antibodies 446
causes of infertility 444
diagnostic hysteroscopy prior to IVF 446
duration of infertility 443
endometrial biopsy 447
endometrial injury 447
history of previous pregnancy 444
maternal age 443
obesity 445
presence of fibroid 446
rank of IVF attempts 444
smoking 445
Controlled ovarian stimulation 447
ovarian stimulation protocols 447
Corpus luteum 106
Counseling 7
Cryomyolysis 229
Cryopreservation in ART 581
advantages and disadvantages 583
applications for embryo freezing 582
clinical management of frozen embryo transfer cycles 582
replacement in a hormone controlled cycle 582
replacement in a natural cycle 582
cryopreservation and patients undergoing cancer therapy 585
oocyte freezing 586
ovarian tissue freezing 586
history 581
regulation of human embryo freezing 584
results of frozen embryo transfer 583
Cryopreservation of oocytes and embryos 588
Cumulus – corona morphology 537
Cystogenetics 149
Cytogenetic studies in spermatozoa 152
Cytogenetics of infertile men 153
Cytoplasmic abnormalities 540
Cytoplasmic maturation 539
Cytoplasmic vacuoles 531
D
Danazol 12
Declining fertility 82
Diabetes and erectile dysfunction 195
Diethylstilbestrol 223
DNA fingerprinting 551
E
Ectopic pregnancy 269, 296
diagnosis 296
epidemiology 296
management options 297
management with methotrexate 297
contraindications 297
indications 297
laparoscopy over laparotomy 298
multiple dose regimen 298
pretreatment evaluation 297
salpingostomy 299
side effects 298
single dose regimen 297
segmental excision 301
salpingectomy 302
Ejaculatory disturbances 188
Electroejaculation 192, 205
Embryo assessment 541
Embryo donation 463
ethical and social implications 463
payment 464
Embryo quality 544
Embryo replacement 21
Embryo selection methods 537
Embryo transfer 15, 438, 449
Endometrial growth 35
Endometrial polyps 221
Endometrial receptivity 20, 224
Endometrial thickness 37
Endometrioma and infertility 285
Endometriosis 269, 277
adjunctive surgical procedures 284
clinical presentation 278, 288
diagnosis 278
medical management 279
aspiration of endometriomas 280
medical management 287
add-back therapy 291
analgesics 289
anti-angiogenic therapies 293
anti-inflammatory 293
aromatase inhibitors 292
cyproterone acetate 290
danazol 292
gestrinone 292
GnRH analogs 291
GnRH antagonists 291
hormonal 289
immunomodulators 293
norethisterone acetate 289
progestins 289
pathogenesis 277
surgical management 280
treatment from patient's view 293
types 288
Endometriosis 32, 48
Endometriosis of the uterus 34
Enzyme-linked immunosorbent assay 72
Erectile dysfunction 194
Estradiol 108
Ethical issues of infertility 634
Extracytoplasmic abnormalities 540
F
Falloposcopic transfer of gametes 456
Female factor infertility 30
Fibroid 32, 48, 305
anatomic classification 308
cytokines and growth factors 308
diagnostic modalities 309
etiology
age 305
body mass index 306
childbearing 306
cigarette smoking 307
diet 307
family history 306
infectious agents 307
medical conditions 307
menstrual history 306
oral contraceptive pills 306
pelvic inflammatory disease 307
physical activity 306
race 305
genetics 307
prevalence 305
symptoms 309
Fibromyoma 305
Fine needle aspiration cytology 182
First polar body 539
Follicle stimulating hormone 359
Follitropin 354
Fragmentation 544
Future of third-party reproduction 483
G
Gamete intrafallopian transfer 453
difficulties with 454
embryologist's role 454
laboratory facilities required 454
ovulation induction 454
screening 454
Gestrinone 12
Ghrelin 114, 139
Giant oocytes 539
GnRH agonist analogues 336
GnRH antagonists 12, 337
Gonadotropin 79, 117, 333, 447
Gonadotropin releasing hormone 367, 369
Gonorrhea infection 62
impact on fertility 62
treatment 63
Granular cytoplasm 530
H
Haploidization of somatic cells 606
embryo development 611
embryo normality following 606
haploidization and imprinting 607
microinjection 610
oocyte activation 611
preparation of adult fibroblasts 610
preparation of embryonic stem (ES) cells 609
preparation of oocytes and cumulus cells 609
the procedure 608
Hirsutism 123, 124
etiology 124
evaluation of patient 125
investigations 126
pathophysiology 124
treatment 126
Human chorionic gonadotropin 368
Human sperm and egg 155
contribution to fertilization 157
oocyte activation by sperm 159
sperm head 157
sperm midpiece and tail 163
sperm neck 160
contributions of the sperm cell to ICSI 163
derivation of ESC from embryos 167
oocyte activation 165
structure of the oocyte 156
structure of the sperm cell 155
Human chorionic gonadotropin 108
Hyperandrogenism 112, 123
Hyperinsulinemia 112
Hyperprolactinemia 95, 96, 131
diagnosis 97
effect on female reproductive function 96
effect on male reproductive function 96
prolactinomas and infertility 97
treatment 98
medical therapy 99
radiotherapy 100
surgery 100
Hyperstimulation 19
Hyperthyroidism 102
diagnosis 102
effects 102
female fertility 102
male fertility 102
treatment 103
Hypogonadotropic hypogonadism 132
Hypo-osmotic swelling (HOS) test 558
Hypoplasia/agenesis 221
Hypospermia 175
Hypothalamic-pituitary dysfunction 334
Hypothyroidism 103, 132
diagnosis 104
effects 104
female fertility 104
male fertility 104
treatment 105
Hysteroscopic surgery 259
diagnostic 259
operative 260
Hysteroscopic tubal cannulation 248
methods 249
balloon catheters 251
falloposcopic guide cannulation 251
flexible guide wire through a tubal catheter 250
linear eversion cannula 251
practical points 252
I
ICMR guidelines for surrogacy 487
ICSI in azoospermia 181
Immature oocytes and their use in ART 521
Immunobead test 72
Immunologically induced infertility 67
ASAB and IVF outcome 69
clinical effects of antisperm antibodies 69
diagnosis 69
etiology 67
immune responses 69
intrauterine insemination 68
for the female 69
for the male 68
Implantation 321
control of endometrial receptivity 323
embryonic and endometrial synchronization 323
hormones, genes, and the implantation 326
importance of pinopodes 325
newer understanding in process 326
physiology 322
adhesion 322
apposition 322
invasion 322
preparation 322
surface morphology of the human endometrium 323
controlled ovarian hyperstimulation cycles 324
hormone controlled cycles 325
natural cycles 324
time 321
In vitro fertilization 15
Infections and infertility 55
assisted reproduction 56
male infertility 57
Infertile couples 4
management protocol 9
medical 10
surgical 14
multiple defects 5
no detectable defect 5
single defect 5
Infertility care units 5
primary 5
secondary 6
tertiary 7
Infertility clinics 632
Insulin resistance 12
Insulin sensitizing drugs 117
Integrins 224
investigation 224
diagnostic hysteroscopy 227
uterine artery Dopplers 226
treatment 228
Intracytoplasmic sperm injection 555
follow-up of ICSI children 563
cognitive and neuromotor development 564
genetic considerations 563
ICSI and psychosocial wellbeing 565
risk of birth defects 564
ICSI procedure 560
indications 556
female factor infertility 556
oocyte preparation 557
preimplantation genetic diagnosis 556
preparation of sperm 557
procedural details 557
preparation for ICSI 559
denudation pipettes 560
media and chemicals 560
MI micropipettes 559
risks of ICSI for women 565
Intracytoplasmic sperm injection 569
instrumentation and methodology 569
air-filled injection and holding units 574
alignment of injection and holding pipettes 576
bending of microinjection needle holding pipette 573
commercial microinjection needles 574
ejaculated sperm for ICSI 575
lubricant-filled injection and holding units 574
microforge 572
microinjection dist 575
micromanipulation system 569
micropipette grinder 572
micropipette puller 571
preparation of a holding pipette 573
preparation of capillary 571
preparation of microinjection pipettes 571
preparation of oocytes for ICSI 574
spiking the needle 572
storage and thawing 577
storage of holding pipettes and microinjection needles 573
testicular sperm for ICSI 575
technique of ICSI 577
ICSI with immotile spermatozoa 579
ICSI with testicular sperm 578
ICSI with very few sperm 578
immobilization of sperm 578
positioning of the oocyte 577
Intracytoplasmic sperm injection 576
Intrauterine adhesions 260
Intrauterine insemination 22, 415
controlled ovarian stimulation 420
counseling 419
female factor 416
anthropometric parameters 416
baseline hormones 417
laparoscopy and hysteroscopy 417
improving sperm quality 427
addition of substances 428
effect of the abstinence period 428
methods of sperm preparation 427
treatment strategy in male subfertility 428
types of IUI catheters 428
indications of IUI 419
male factor 418
male subfertility and IUI 425
immunological male subfertility 427
ovarian stimulation with gonadotropins 422
patient selection and management 416
semen quality and IUI 425
use of antagonists in IUI 423
Intrauterine insemination 68
In vitro fertilization 80
Irregular oolemma 530
IVF and ICSI 183
IVF laboratory 449
burning in 504
changing room 503
cryopreservation room 503
laboratory area 500
operation theater 502
personnel 504
quality assurance 504
recovery room and washing area 503
requirements 502
semen sample collection room 503
storage room 503
IVF laboratory 506
quality control 506
air quality 508
antisperm antibody hemagglutination test 73
antisperm antibody latex agglutination test 72
antisperm antibody leatex agglutination 72
bioassays 509
cytotoxic contaminants 507
enzyme-linked immunosorbent assay 72
equipment monitoring 506
fanning 71
Franklin and Duke's test 71
immunobead test 72
immunofluorescence test 73
indirect IBT 72
Kibricks's gelatin agglutination test 71
laboratory tests 70
mixed agglutination reaction 71
radio labeled antiglobulin assay 71
sperm mucus contact test 70
tray agglutination test 71
water 507
treatment for antisperm antibody 73
artificial reproductive techniques 75
condom therapy 73
corticosteroid therapy 73
cyclosporine therapy 74
embryo transfer 75
enzyme therapy 73
gamete intrafallopian transfer 75
immunization with the partner's lymphocytes 74
in vitro fertilization 75
in vitro processing 74
intrauterine insemination 74
occlusion therapy 73
Laparoscopic ovarian surgery 118
Laparoscopic surgery 298
Laparoscopic tubal microsurgery 254
equipment and instruments 254
microinstruments 255
pre-requisites of surgeon 256
principles 254
surgical technique 256
anastomosis 256
fimbrioplasty 257
hydrosalpinges 257
Legal implications of donor oocyte program 462
Leiomyoma 221, 305
Leiomyomata uteri 261
Leptin 113, 138
LH/FSH surge 369
GnRH agonist-induced 370
Low-dose FSH 117
Luteal phase and GnRH agonist 370
Luteal phase defect
pathophysiology 106
supported assisted reproduction 107
duration of luteal support 108
luteal support protocols 107
need of luteal support 107
treatment 106
Luteal phase defect 48, 224
Luteal support 21
Luteinized unruptured follicle 47
M
Meiotic studies of chromosome anomalies 152
Male factor infertility 29
Male infertility 179
Management protocol of infertile couple 9
medical 10
endometriosis 11, 13
male infertility 14
non-ovulation 10
unexplained infertility 13
surgical 14
assisted reproductive technology 15
complimentary 15
obligatory 14
Mayer-Rokitansky-Kuster-Hauser syndrome 130
Media for embryo culture 514
complex tissue culture media 514
sequential media 514
simple optimized media 514
simple salt solution with added energy substrates 514
Medroxyprogesterone acetate 306
Meiotic spindle detection 540
Menstrual cycle 37, 46
Metabolic assessment of embryos 549
Metabolic syndrome 140
Metformin 117
Micro epididymal sperm aspiration 182
Micro tools 559
Microdissection testicular sperm extraction 183
Microepididymal sperm aspiration 205,208
Micromanipulation 21
Microsurgery in infertility 265
abandoned adjuvants 273
adjuvants to microsurgery 270
benign ovarian tumors 269
distal tubal occlusion 268
ectopic pregnancy 269
endometriosis 269
macrosurgical implantation 266
microsurgical tubocornual anastomosis 266
mid-tubal block 267
ovarian cysts 269
principles 265
tubal surgery 266
Microsurgical vasoepididymal anastomosis 181
Microsurgical vasovasal anastomosis 180
Minimally granular cytoplasm 530
Mixed agglutination reaction 71
Mullerian anomalies 130
Multinucleation 545
Mycoplasma infection 64
impact on fertility 64
predisposing factor 65
treatment 65
Myolysis 313
Myomas 270, 305, 310
decision making in fibroids with infertility 316
in vitro fertilization 310
medical therapy 314
add back therapy 314
aromatase synthetase inhibitors 316
cytotoxic gene therapy for fibroids 316
danazol 315
gonadotropic releasing 315
gonadotropin releasing 314
hormone agonists 314, 315
interferon 316
levonorgestrel-releasing 315
mifepristone 315
selective estrogen receptor modulators 315
tamoxifen and raloxifen 315
tibolone 315
myomectomy and infertility 311
recurrence 316
surgical treatment 311
abdominal myomectomy 312
hysteroscopic resection 312
myolysis 313
myomectomy 311
thermal ablation under MR guidance 313
uterine artery embolization 313
N
Necrozoospermia 179
Nocturnal penile tumescence 187
O
Obesity 136
effect of obesity on 140
management 141
metformin 143
orlistat 142
phentermine 142
rimonabant 142
sibutramine 142
obesity and reproductive health 137
effect of obesity on assisted reproduction 138
influence of obesity on natural fertility 137
obesity and PCOS 138
pathophysiology 138
types 137
OHSS and GnRH agonist 371
Oligoasthenoteratozoospermia 180
Oocyte donation 454, 489
acceptance criteria 490
counseling 490
evaluation of oocyte recipients 459
evaluation of the partner of the oocyte recipient 459
pregnancies in oocyte recipient 462
procedure 455
screening and testing of oocyte donors 460
screening tests for donor 490
screening tests for recipients 490
selection of the donor 459
success of oocyte donation 460
Oocyte mitochondrial morphology 551
Oocyte quality 529
abnormal oocyte 530
cytoplasmic abnormalities 530
extracytoplasmic abnormalities 532
causes of oocyte dysmorphism 529
classification of oocyte anomalies 530
normal oocyte 530
Oocyte retrieval 436
Orgasmic disturbances 194
Ovarian cancer 402
further evidence 403
hypotheses for occurrence 403
inclusion cysts 403
ovulatory age 403
stimulation of epithelial inclusion cyst 403
women's perception of risks and benefits of therapy 405
Ovarian evaluation 41
confirming ovulation 43
endometrium 44
follicular development 42
ovarian study 42
ovary in anovulatory cycles 44
prediction of ovulation 42
Ovarian follicular stimulation 350
historical review 350
management of stimulation cycles 353
Ovarian hyperstimulation syndrome 385
approach for particular symptoms 391
particular medication 392
pleural puncture 392
classification 385
coasting 396
complication 389
cryopreservation 397
early and late forms 385
essential characteristics 385
etiology 386
incidence 385
intravenous albumin for prevention 396
levels of severity 390
prevention 393
endocrine monitoring 394
follicular monitoring by ultrasound 394
identification of patients at risk 393
identification of polycystic ovary disease 393
risk of OHSS during ovarian stimulation 394
stimulation protocols 393
preventive measures 395
triggering ovulation and OHSS 395
withholding hCG and cycle cancellation 395
treatment 389
Ovarian hyperstimulation syndrome 49
Ovarian vascularity 47
Ovulation induction 115, 119, 340
current methods 341
hormonal monitoring 342
monitoring of endometrial development 345
monitoring protocol 347
need for monitoring 340
traditional methods 341
ultrasound monitoring 343
confirmation of ovulation 344
follicular dynamics 343
prediction of ovulation 344
prevention of OHSS 344
timing of hCG 344
P
Paracentesis 391
Patient selection 3
husband 3
wife 4
Pelvic inflammatory disease 64
Pelvic tuberculosis 57
clinical features 58
diagnosis 58
pathology 58
treatment 58
surgery 60
Penile prosthesis 198
Percutaneous epididymal sperm aspiration 208
Perimplantation genetic diagnosis 595
potential advantages 597
risks involved in PGD 597
ethical implications of PGD 603
HLA matching for an existing child 601
PGD for achondroplasia 601
PGD for alpha 1-antitrypsin deficiency 599
PGD for Canavan disease 600
PGD for cystic fibrosis 601
PGD for Down syndrome 601
PGD for FA combining with HLA matching 599
PGD for Fanconi anemia (FA) 599
PGD for fraglile X 597
PGD for gender selection 602
PGD for non-medical traits 602
PGD for sickle cell anemia 598
PGD for susceptibility and late on-set conditions 601
sex determination 601
Pinopodes 322
Pituitary down-regulation 336
Polar body 532
Polycystic ovarian disease 48
Polycystic ovarian syndrome 134
Polycystic ovary syndrome 110
assisted reproductive technologies 118
clomiphene citrate 115
alternative therapies 116
combination therapy 116
insulin-sensitising drugs 116
diagnostic criteria 110
AES criteria 111
NIH criteria 110
rotterdam criteria 110
genetics 112
hyperandrogenism 112
hyperinsulinemia and insulin resistance 112
insulin resistance 112
laparoscopic ovarian surgery 118
management of infertility 114
lifestyle modifications 114
obesity and PCOS 113
pathogenesis 111
pathophysiology 111
Polycystic ovary syndrome 334
Polyps 262
Polyvinylpyrrolidone 576
Poor response to ovarian stimulation 378
altering strategies 380
alternative strategies 382
GnRH-agonists 380
role of growth hormone therapy 382
role of recombinant FSH 380
definition 378
predicting a poor response 378
age 378
baseline serum FSH 378
baseline serum LH 379
dynamic tests 379
inhibin 379
new diagnostic possibilities 379
serum estradiol 379
ultrasound 379
Preimplantation genetic diagnosis 448, 550
Preimplantation genetic screening 551
Premature ejaculation 189
Premature ovarian failure 134
Progesterone 108
Progestogens 12
Perivitelline space 533
Prolactin 95
chemical composition 95
control of secretion 95
functions 96
normal values 96
pattern of secretion 96
sites of secretion 95
Pronuclear – stage embryo 541
Prostaglandin synthetase inhibitors 12
Proximal tubal block 248
Proximal tubal occlusion 266
Psychological aspects of infertility 85
alternative means of achieving pregnancy 89
psychological support 89
time of pregnancy 87
treatment 87
understanding the grieving process 87
Q
Quetlet index 136
R
Radio labeled antiglobulin assay 71
Recombinant FSH 350, 358
biological role 359
clinical applications 359
controlled ovarian hyperstimulation 360
FSH versus human menopausal gonadotropin 360
treatment of anovulatory infertility 360
LH ceiling concept 359
recombinant versus urinary FSH in ART 362
r-FSH in ART 360
r-FSH and GnRH antagonists 360
r-FSH and GnRH-agonist 360
sequential low-dose protocol 361
two cell, two gonadotrophin theory 359
Recombinant gonadotropins 354
Rectal adhesiolysis 282
Referral system 5
Refractile body 532
Regulation of assisted reproductive technology 625
advantages and disadvantages 628
ethical issues 629
legislation 626
upon clinical and scientific practice in the UK 626
assessing clients 627
complaints 628
consent 627
counseling 627
facilities 626
information 627
records 628
research 628
staff 626
storage and handling of gametes 628
use of gametes and embryos 627
welfare of the child 627
Resistant ovarian syndrome 131
Retarded ejaculation 189, 194
Round spermatids 184
S
Salpingectomy 299, 302
Scrotal sonography 29
Selecting the best embryo 548
Semen analysis 170,171
abnormal semen picture 175
composition of semen 170
constituents of normal semen 170
method of collection 173
estimation of spermatozoa concentration 174
semen variables 173
specimen handling 173
physical properties 170
macroscopic properties 170, 171
place of collection 171
semen collection container 171
Seminal vesicle sperm aspiration 204
Septate uterus 34, 223
Sexual dysfunctions 186
biological basis of sexual response 186
changing practice patterns 196
combined injection and stimulation test 187
diagnostic algorithm 198
erection and ejaculation 187
oral pharmacotherapy 197
Sheehan's syndrome 135
Sion test 40
Smooth endoplasmic reticulum 531
Sonohysterography 33, 40
Sperm mucus contact test 70
Sperm preparation 176, 557
Sperm retrieval methods for ICSI 182
Sperm retrieval techniques 202
anesthetic considerations 205
comparison of TESE and TESA 207
comparison of TESE and testicular biopsy 206
complications of SSR 208
contraindications 206
indications for TESE and TESA 206
interval between two SSR attempts 208
methods of surgical 203
physiology of surgical 203
prognostic factors 205
repeated attempts of SSR for NOA 207
selection of area for TESE or TESA 206
sperm retrieval 203
micro epididymal sperm aspiration 204
microdissection TESE 203
percutaneous epididymal sperm aspiration 204
testicular sperm aspiration 203
testicular sperm extraction 203
sperm retrieval for obstructive azoospermia 207
spermatids and TESE 206
SSR for non-obstructive azoospermia 206
success rate 209
Spindle imaging 534
Stem cell 616
human embryonic stem cells 617
cell culture 618
cells for therapeutic transplants 618
derivation 617
isolation 618
potential use 619
properties 617
types 616
embryonic 616
pluripotent 616
totipotent 616
unipotent 616
Stem cell therapy 621
Stimulation protocol 18
Stress and infertility 8
Submucous fibroid 261
Superovulation 80, 333
Surrogacy 475, 486
counseling 478
cycle management 478
ethical issues 480
ICMR guidelines 479
patient selection 475
screening of the surrogate 476
selection of the surrogate 476
surrogacy and law 479
Surrogate house 486
advantages 486
for the couples 486
for the surrogate 486
Sex chromosomal abnormalities 149
46,XX males 149
abnormalities of Y chromosome 150
microdeletions on Y chromosome 151
numerical abnormalities 149
reciprocal translocations 150
T
Testicular sperm aspiration 203
Testicular sperm extraction 183
Thyroid disorders 102
Transrectal ultrasonography 30
Transvaginal color Doppler sonology 46
Trichomoniasis 63
clinical presentation 63
impact on fertility 63
treatment 63
Tubal evaluation 40
Tubal factor of infertility 231
ectopic pregnancy and tubal infertility 235
evaluation of tubal factor 231
factors affecting the ART results 233
hydrosalpinx in success of IVF 233
infertility and normozoospermia 236
ovarian function 235
tubal infertility and implantation rate 234
tubal surgery in the era of ART 233
Tuberculosis 130, 223
Turner's syndrome 130
U
Ultrasound guided assisted reproduction techniques 49
Unexplained infertility 77
chances of conception and age 77
embryo development and genetics control 78
investigations for infertility 78
molecular control of the implantation window 78
semen analysis and fertilising capacity 78
testing 77
treatment 79
expectant management 79
in vitro fertilization/GIFT 80
role of ovulation induction 79
uterine receptivity 78
Unicornuate uterus 222
Urinary alkalization 190
Uterine artery embolization 313
Uterine factor infertility 30, 220
Uterus didelphys 222
V
Vaginal and cervical factor infertility 30
Vaginosonographic follicular aspirations 49
Vaginosonographic puncture procedures 50
assisted reproduction techniques 50
complications 50
direct intra-follicular insemination 51
direct intraperitoneal insemination 51
embryo transfer 51
patient preparation 50
peritoneal oocyte sperm transfer 51
procedure 50
Vasography 181
Vibratory stimulation 191
Virilization 123
circulation 124
production in women 123
Vitrification 589
basic principles 589
clinical results 591
special applications 592
vitrification of human oocytes 591
Z
Zona pellucida 533
Zona pellucida thickness 546
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