Infertility

Infertility, as with many aspects of medicine, is at the mercy of rapid technological advance. Many of these developments initially seem attractive to both clinicians and patients, but need to be rigorously assessed if their real value is to be understood and clinical practice is to develop. In this book issues of importance to the management of infertile patients are discussed. The gaps in our knowledge which prevent a better understanding of the condition are identified, and recent developments, both clinical and scientific, are subjected to peer review and discussion. An important feature of the book is an acceptance that training in infertility practice is a real problem. This is perceived not only by the practising clinicians, both doctors and nurses, but particularly by the clinical scientists, including embryologists, who now provide such an essential part of the service. Similarly the provision of the clinical service has been examined in detail from a variety of standpoints, in an attempt to make sensible recommendations which balance real need with limited resource. The book is based on the papers presented and discussed at the 25th RCOG Study Group held in April 1992. The discussion after each paper was civilised but uncompromising and forms an important part of this publication. The rapid processing of the written and recorded material by the staff at the RCOG, and particularly Miss Sally Barber, has ensured that the book has been produced while the issues are live, the reviews contemporary and the discussion relevant. Front Matter....Pages i-xiv Front Matter....Pages 1-1 Reproductive Trends in the UK....Pages 3-21 The Epidemiology of Infertility....Pages 23-32 The Causes of Infertility and Relative Effectiveness of Treatment....Pages 33-62 Front Matter....Pages 63-63 Male Infertility Due to Testicular Dysfunction....Pages 65-79 Diagnosis of Male Infertility....Pages 81-100 Sperm Preservation: Fundamental Cryobiology and Practical Implications....Pages 101-114 Sperm-Egg Manipulation for the Treatment of Male Infertility....Pages 115-132 Epididymal Surgery....Pages 133-153 Front Matter....Pages 155-155 Tubal Physiology and Function....Pages 157-168 Falloposcopy....Pages 169-184 The Role of Reproductive Surgery....Pages 185-198 Advanced Videolaparoscopy and Videolaseroscopy....Pages 199-214 Surgery and the Polycystic Ovarian Syndrome....Pages 215-227 Manipulation of the Ovarian Cycle....Pages 229-236 Induction of Ovulation....Pages 237-250 Front Matter....Pages 251-251 Cryopreservation of Mammalian Oocytes....Pages 253-261 Extracorporeal Development of Immature Ovarian Follicles....Pages 263-278 Egg and Embryo Donation: Implantation Aspects....Pages 279-289 The Social Aspects of Ovum Donation....Pages 291-300 Egg and Embryo Donation: Legal Aspects....Pages 301-316 Front Matter....Pages 251-251 Embryo Micromanipulation....Pages 317-330 Preimplantation Diagnosis of Genetic Defects....Pages 331-342 Front Matter....Pages 343-343 Training in Infertility: the Role of the Royal College of Obstetricians and Gynaecologists....Pages 345-350 Infertility Nurses and Counselling....Pages 351-361 Training and Accreditation of IVF Embryologists....Pages 363-377 Front Matter....Pages 379-379 The Patients’ Viewpoint....Pages 381-388 Service Provision: A Tertiary Clinic Director’s View....Pages 389-397 Public Health Aspects of Subfertility....Pages 399-420 Back Matter....Pages 421-433 The RCOG regularly organizes Study Groups to investigate topics of major concern among practicing specialists. The interdisciplinary nature of their reports and the expertize of the invited participants guarantees the high quality of the RCOG reports. The quick publication ensures that new information does not remain the exclusive advantage of the few, but the immediate tool of all gynecologists and obstetricians