Practical Problems in Assisted Conception PDF download

Practical Problems in Assisted Conception PDF Free Download

Preface:

Considering life as an in vitro fertilization (IVF) doctor leads one to think that IVF has always been readily available, but this is not so. I did my first infertility clinic in 1959 as a Senior House Officer in Australia; it had already been differentiated from the gynecology clinic because of the number of patients. A hysterosalpingogram provided evidence for tubal macrosurgery, semen analysis was not standardized and there was no endocrine test for ovulation nor any means to stimulate it. A patient went abroad for donor insemination. After extensive clinical training and research in endocrinology, I ran an infertility clinic in Wales in 1969, although tubal surgery was still the only treatment used. Urinary total estrogen and pregnanediol assays in 24-hour urine samples became possible and clomiphene and human menopausal gonadotropin (hMG) were introduced.Multiple pregnancies followed in spite of urinary estrogen monitoring that used the postal service to send samples to a distant lab, the results being phoned through the following day. In 1973 I established my infertility clinic in Sheffield, by which time it was possible to measure serum hormones. Prolactin measurement led to a search for pituitary microadenomas, and bromocriptine was extensively used before it was fully appreciated that prolactin was also a stress hormone. Laparoscopy was developed into an important diagnostic tool and became essential to define peritubal and periovarian adhesions, better dealt with by microsurgery, as was tubocornual obstruction. Sperm cryopreservation using slow freezing became practical after earlier use in animal husbandry and sperm donation then became feasible. Sperm banks developed, so donors were screened, interviewed and counseled, as were the couples; it was recognized that counselors had a role and needed specific training. Sperm banks made donations available for sale to other clinics and trade flourished. During this time the World Health Organization (WHO) developed its Task Force on the Diagnosis and Treatment of Infertility, began optimizing semen analysis and structured a formal evaluation of both female and male history, physical examination and investigation.

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