Over the past 10 years, studies have shown that the rates of fertility vary in different ethnic groups. Ethnic differences also play a significant role in the outcome of assisted reproductive technology (ART) cycles. In the United States, minority groups--African Americans, Hispanics (mainly Mexicans and Central Americans), East Asians (Chinese, Japanese, Koreans, Philippinos) and South Asians (Indians, Pakistanis, and Bengalis)--have significantly lower chances of live births compared to Caucasian women. Birth outcome data collected by the Society for Assisted Reproductive Technology shows a worsening trend in conception rates between the years 1999-2000 and 2004-2006, raising more concern that the disparity in fertility rates between minority groups and white women is widening over time. This comprehensive book serves to answer the questions that arise when managing infertility in a multi-ethnic population. An expert assembly of key leaders in the field of reproductive medicine imparts insight and clinical experience in order to identify and analyze the possible causes of racial disparities in fertility outcome. Some of the reviewed causes include higher Body Mass Index (BMI), tubal diseases, metabolic syndrome, and fibroids in African Americans; tubal disease and higher early pregnancy loss in Hispanics; higher incidence of diminished ovarian reserve and lower BMI in East Asians; and higher incidence of polycystic ovarian disease (PCOS) in South Asians. The book also provides a review of data on access to care and ART services in developing countries. A thoughtful combination of evidence-based medicine and advanced treatment options, this book is sure to distinguish itself as the definitive reference on ethnic differences in assisted reproduction.

Non-Invasive Sperm Selection for In Vitro Fertilization summarizes and discusses the relevant literature on the various advanced sperm selection methods used in modern Assisted Reproductive Technologies (ART). Chapters review some of the major unresolved issues in the field, the feasibility and success of the various sperm selection methods, their safety and the effects they have on sperm quality and ART outcomes. The book makes recommendations on clinical applications and future research, while helping to elucidate the benefits and promise of non-invasive sperm selection techniques. A distinguished team of scientists, embryologists, and urologists, with expertise in male infertility and ART, contributes to this original and valuable reference guide meant for academics, researchers, and professionals in the field of reproductive medicine who need an update on the current status of the study and practice of non-invasive sperm selection techniques.

This contributed volume regenerates the significance of and respect for natural phenomenon in the background of the risks and complications seen in ART such as ovarian hyperstimulation and multiple pregnancies. Balancing the clinical practice between the beneficial natural physiology and the prolific use of stimulation drugs for ART may help eliminate risks that may prove clinically, financially and psychologically expensive. It underscores the fact that 'greater' is not always synonymous with 'better' with regard to the oocyte yield. While highlighting the risks involved with the use of high-dose gonadotropins, the book presents a stratification of patients who might benefit from the 'soft' minimal and natural cycle IVF stimulation protocols that may be used. Additionally, clinicians can understand the significance of cryopreservation technology, now a useful adjunct to minimal stimulation protocols, with its manifold future advantages. Written by an international team of experts, this handbook emphasizes how minimal stimulation and natural cycle IVF can lead to a milder, safer and more effective approach to ART.

The oocyte is the largest and most mysterious cell in the body of mammalian organisms. Through its growth and maturation, it reaches extreme levels of specialization, while maintaining at the same time a condition of totipotency. Its unique ability, in co-operation with the spermatozoon, to give rise to a fully developed organism formed from hundreds of different tissues and myriads of individual cells has inspired intellectuals of all ages. Oogenesis finds impetus and purpose in casting scientific perspective towards this unique cell for the benefit of scientists and assisted reproductive technology (ART) specialists. The authors of the chapters are distinguished authorities in their respective areas of competence. From the opening of the book the reader is lead on a fantastic voyage from the formation of the primordial oocyte to the development of the early embryo, passing through crucial processes of oogenesis, such as co-ordination of oocyte and follicle growth, gene expression and organelle reorganization during growth and maturation, epigenetic mechanisms, regulation of meiosis, totipotency, cell polarity, oogenesis in vitro and maternal regulation of early development.

This book provides andrologists and other practitioners with reliable, up-to-date information on all aspects of male infertility and is designed to assist in the clinical management of patients. Clear guidance is offered on classification of infertility, sperm analysis interpretation and diagnosis. The full range of types and causes of male infertility are then discussed in depth. Particular attention is devoted to poorly understood conditions such as unexplained couple infertility and idiopathic male infertility, but the roles of diverse disorders, health and lifestyle factors and environmental pollution are also fully explored. Research considered stimulating for the reader is highlighted, reflecting the fascinating and controversial nature of the field. International treatment guidelines are presented and the role of diet and dietary supplements is discussed in view of their increasing importance. Clinicians will find that the book's straightforward approach ensures that it can be easily and rapidly consulted.

The decade that has passed since publication of the second edition of this textbook has not only witnessed a tremendous increase in knowledge within the ? eld of and- logy, but also seen the ? eld itself achieve a newfound status within the medical p- fession. Knowledge and status have been of mutual bene? t to the ? eld and the growing critical mass of diagnostic and therapeutic possibilities have caused andrology to be recognized as a medical subspecialty in some countries such as Germany, Poland, and Estonia. The European Academy of Andrology (EAA) served as a pacemaker for this development and continues to strive for establishment of andrology as a clinical ? eld. Well-designed curricula and qualifying examinations have contributed to the of? cial recognition of andrology as a speciality. This recognition of the ? eld helps patients with andrological problems to ? nd the specialist they seek. This textbook summarizes the current state of knowledge in the ? eld of andrology. It is a source of knowledge to all those who are or want to become andrologists. In addition, as andrology is clearly an interdisciplinary ? eld, this book may serve as a compendium and source of reference for all those physicians and biologists active in neighboring areas, who want to obtain an overview of andrology and who require information on special problems. The extensive references are timely and up to date.

This concise and practical book is the first of its kind to examine the use of assisted reproductive technologies (ART) in relation to blood-borne infectious diseases: human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV). The book opens with a discussion of the impact of these viruses on male and female fertility, followed by specific chapters of each of them, including ART with HIV and HCV serodiscordant couples (where either the male or female is positive) and the detection and impact of HBV and HCV in human gametes and embryos. An important character on laboratory safety when performing ART with blood-borne viruses follows, and the book concludes with a discussion of ART in austere and resource-poor settings, where these infections are often dominant due to lack of treatment and access to vaccines. Written and edited by an international array of experts in reproductive medicine, Assisted Reproductive Technologies and Infectious Diseases explores questions, techniques, and related issues with the aim of effectively helping clinicians working with serodiscordant couples wishing to have children.

This atlas provides sequential pictures for most existing reconstructive urology procedures. Though the use of technology is described, the book has been constructed in such a way that urologists from all countries will be able to pickup the technical tips to perform the laparoscopic procedures using simplified devices.

Reproductive medicine is a growing field with new technology emerging faster than we can assess consumer's perceptions of -the number of cancer survivors are growing and there is a great need to attend to their quality of life-this book addresses the needs of males and females, identifies effective communication strategies and proactive measures for health care professionals and researchers to use as well as identifying gaps in the literature where more research is needed.

Infertility is defned as the inability to conceive after having unprotected intercourse for a year. Infertility is increasing worldwide and has various causes both in the male and the female partner. Immune reactions to sperm can contribute up to 2-30% of infertility. The sperm has both autoantigenic as well as isoantigenic potential, and is thus capable of p- ducing antisperm antibodies (ASAs) and sperm-reactive T cells in both infertile men and women. Also, over 75% vasectomized men produce autoantibodies to sperm that can cause a problem in regaining fertility even after successful re-anastomosis in vasovasostomy. Early claims regarding the incidence and involvement of ASAs in involuntary human infertility were probably overemphasized because of unreliable techniques and naivety concerning the complexity of the immune response and antigenic nature of the sperm cell. These factors, the lack of well-designed and controlled experimental studies, and the dearth of effective therapeutic modalities resulted in the confusion of the occurrence and importance of ASAs in human infertility. Consequently, evaluation of infertile couples for ASAs and their possible role in infertility was not considered a signifcant proposition. The development of more accurate assays and the discovery of mucosal immunity capable of responses independent of systemic immunity have caused inclusion of sperm cells and genital tract secretions in the analysis of ASAs.

In the last decades, major advances have been made in assisted reproductive technologies (ART) and the public demand for these procedures has increased globally. All ART clinics, from those just starting out to the well established, must employ the latest equipment and implement the best practices, while ensuring that their resources are effectively engaged to optimize patient outcomes. This is a tenet of the fiduciary role of physicians and it is increasingly recognized as a quantifiable goal regulated by formal certifications and accreditations. Quality management protocols such as those proposed by the International Organization for Standardization (ISO) are being rapidly adopted as standards of measure. Quality Management in ART Clinics: A Practical Guide provides easily adoptable ways to implement and improve formalized quality management systems. Essential to any clinic to achieve best practices and maintenance of formal regulatory certifications, this book brings together the know-how of experienced opinion leaders operating in key areas worldwide. The book offers an overview of primary regulations in the ART field, with attention to quality management demands, and links specific requirements to practical steps for implementation. Filled with process and procedure examples, flow diagrams and administrative form templates, this book is the first of its kind, gathering the necessary elements for optimizing practice, management, and quality assurance.

Oncofertility is a specialty that bridges the disciplines of reproductive endocrinology and infertility and oncology, with the goal of expanding the reproductive options of cancer patients. Given fertility risks associated with specific cancer treatments, as well as the improved long-term survival made possible by these therapies, there has been growing interest in expanding reproductive options for cancer patients. Indeed, both cancer survivors and the medical community have acknowledged the importance of patient counseling and the pursuit of fertility preservation options prior to starting cancer treatment. Oncofertility Medical Practice: Clinical Issues and Implementation is the third in a series of timely and indispensable books on fertility preservation for cancer patients-the first one focused on advances in basic science research and the second one offered ethical, legal, and social perspectives on the theme. This book elucidates the latest practices and emerging treatments in oncofertility and provides necessary information on the successes, risks, and limitations of fertility preserving technologies. Authoritative and insightful, written by an impressive multi-disciplinary cadre of specialists, this book is a valuable up-to-date resource for all those practicing in this demanding field. "This excellent text is an invaluable resource and a "must read" for clinicians and researchers interested in Oncofertility. The editors and authors need to be congratulated for their fine work." Roger A. Lobo, MD, Professor of Obstetrics and Gynecology, Columbia University and Past President of the American Society for Reproductive Medicine

Kisspeptin has been shown to be both necessary and sufficient for activation of the reproductive axis, during puberty and later in adulthood. This makes kisspeptin a fundamental component of the reproductive axis. Kisspeptin has been deemed the single most potent stimulator of GnRH neurons yet known. The importance of kisspeptin has been documented in humans as well as non-human animal models, ranging from monkeys, sheep, and rodents to numerous fish species, thus signifying a highly conserved nature of its reproductive function. Importantly, kisspeptin neurons seem to mediate many of the regulatory effects of other signals, whether they are metabolic, circadian, hormonal, or stress. This places kisspeptin neurons in a unique position to be key nodal points and conduits for conveying numerous endogenous and exogenous signals to the reproductive axis.

This concise, truncated version of Parekattil and Agarwal's "Male Infertility: Contemporary Clinical Approaches, Andrology, ART & Antioxidants" is the first resource dedicated solely to antioxidants and male infertility. With select chapters that will prove invaluable to the practitioner of reproductive medicine, "Antioxidants in Male Infertility" addresses issues such as:

- Molecular mechanisms of antioxidants in male infertility

- Oxidative stress

- The impact of infection, aging, obesity, and injury on male infertility

- Natural and synthetic antioxidants and antioxidant therapy

- Antioxidants in ICSI and IMSI

Also included is a new chapter reviewing the physiological role of reactive oxygen species in sperm function.

Practical for clinicians and researchers alike, "Antioxidants in Male Infertility" contains all of the need-to-know information about these cutting-edge topics in reproductive medicine.

Comprised exclusively of clinical cases covering ectopic pregnancy, this concise, practical casebook will provide clinicians in reproductive medicine and obstetrics/gynecology with the best real-world strategies to properly diagnose and treat the various forms of the condition they may encounter. Each chapter is a case that opens with a unique clinical presentation, followed by a description of the diagnosis, assessment and management techniques used to treat it, as well as the case outcome and clinical pearls and pitfalls. Cases included illustrate different management strategies - from treatment with methotrexate to surgical interventions - as well as types of ectopic pregnancy, such as ovarian, interstitial, heterotopic and abdominal forms, among others. Pragmatic and reader-friendly, Ectopic Pregnancy: A Clinical Casebook will be an excellent resource for reproductive medicine specialists, obstetricians and gynecologists, and family and emergency medicine physicians alike.

In spite of the fact that almost eighty percent of all IVF cycles are unsuccessful, the dominant representations of the technology are of its success. Based on extensive interviews with women and couples who have undergone IVF unsuccessfully and who have since stopped treatment, and taking an overtly feminist approach, the book explores the ways in which IVF failure is experienced and accounted for. The book argues that IVF failure and the end of treatment have to be carefully managed over time in order to construct the self as 'normal' in the profoundly gendered context of reproductive normativity. Treatment failure is identified in the book not only as a central, but largely excluded, aspect of the experience of IVF, but also of a proliferating range of new, more controversial reproductive and genetic technologies.

This textbook takes a new, dynamic approach to the basic sciences in obstetrics and gynaecology. It teaches candidates all they need to know for the MRCOG Part 1 examination by extending the understanding of the basic medical sciences and their relevance to obstetrics and gynaecology. Like conventional textbooks it teaches what is 'true', but it also what is 'false', and why. The most complex concepts are discussed in a problem-based format so that the relevant basic sciences are taught and drawn together in context.

Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning - all desirable generic skills for health care professionals. This volume contains a selection of cases on assisted reproduction that will inform and challenge reproductive medicine practitioners at all stages in their careers. Both common and uncommon cases are included. The aim is to reinforce diagnostic skill through careful analysis of individual presenting patterns, and to guide treatment decisions. Each case consists of a clinical history, examination findings and special investigations, before a diagnosis is made. Clinical issues raised by each case are discussed and major teaching points emphasized. Selective references are provided. The book provides a useful complementary adjunct to existing textbooks of reproductive medicine, and an excellent resource for teaching and continuing professional development.

Ovulation induction and controlled ovarian stimulation lie at the very heart of treatment for infertility, but have been subject to a bewildering variety of variations and improvements over recent years. The Second Edition of this highly successful book updates the reader on the progress and developments in this area. Furthermore, it provides the busy clinician with a reliable overview of the principles involved and the management needed. As with the previous edition, the emphasis throughout this book is on logical evidence and evidence-based solutions supplemented with Professor Homburg's extensive clinical experience gleaned from more than forty years working in the field. A number of highly useful algorithms and explanatory tables reinforce this approach, ensuring that the reader is presented with easy-to-grasp, well-presented information that maximizes clarity and understanding. This book offers a concise, no-nonsense, practical guide to ovulation induction and controlled ovarian stimulation and will be an essential resource for the general gynaecologists, fertility specialists and trainees, health workers and students.

With reproductive medical technologies becoming more accessible, assisted donor conception is raising new and important questions about family life. Using in-depth interviews, Petra Nordqvist and Carol Smart explore the lived reality of donor conception and offer insights into the complexities of these new family relationships.

Historically, sperm have been seen as simply a mechanism of transferring a haploid set of chromosomes to the oocyte. However, data from assisted reproduction therapies (ART) have demonstrated that in many couples the sperm appears to be responsible for abnormal embryogenesis. Recent advances in genetic and epigenetic techniques have identified key mechanisms by which the sperm, and the DNA carried by the sperm, can affect early embryonic development. Paternal Influences on Human Reproductive Success examines the genetic and epigenetic influences on embryogenesis, as well as practical clinical factors related to the male contribution to reproductive success. It also provides 'cutting edge' data and analysis of recent evaluations of the role of advanced paternal age, environmental influences and lifestyle factors on male reproductive fitness, making this an invaluable text for physicians treating patients for infertility, recurrent pregnancy loss, and developmental anomalies, as well as basic scientists studying embryogenesis and spermatogenesis.

This book contributes in an important way to the psychoanalytic understanding and impact of Assisted Reproductive Technology on a majority of patients who have difficulties starting new families. Recent advances in reproductive technology and the increased use of techniques based upon it have created a need for psychoanalytic thinking and understanding of the psychological implications of Assisted reproductive procedures, in-vitro fertilization and other similar procedures.The recent and rapid advances in medical technologies confront us with a mandate in our clinical work to understand their complex impact on women, men, and children. However, attention to the intra psychic conflicts, traumatic experience of the use of such techniques has not been addressed in psychoanalytic literature. The developmental trauma and intra psychic conflicts of individuals using reproductive technologies are ubiquitous, yet it has been neglected as a topic of special interest in our clinical work.The centerpiece of these collective chapters deal with psychic trauma of infertility, the compulsion to repeat through persistent repeated use of assisted reproductive technology, anxiety about motherhood, and finally the lives of children who are born and do not know from where they came.These poignant topics deal with family complexes and the Oedipal circle, repetition compulsion, trials and failures, anxiety related to motherhood, egg and sperm donors, parental identity formation, infertility, trauma, and discussion of a contemporary film depicting the challenging and newly defined family structure.

How do rapid social and technological changes shape reproductive realms today? This book considers the complex choices, anxieties and challenges that come alongside postmodern reproduction for women and men in the West. Topics include surrogacy, fatherhood, sperm banking, egg donation, contraception, breastfeeding, and postpartum body image.

The development of the placenta was a pivotal event in evolution. Without it, we would still be laying eggs instead of giving birth to live offspring. It represents the critical link between the foetus and the mother, but its character is extraordinary - it is, in effect, a foreign tissue that invades the mother's body. Compared to many other animals, the human placenta represents a particularly aggressive body. But how is it managed and controlled? How did such an organ evolve in the first place? And why is it tolerated by the mother? Y.W. Loke, a highly respected expert in the placenta and its development, explores the nature of the placenta and what it can tell us about evolution, development, and genetics.

This gold standard text has kept its readers abreast of rapid advancements in reproductive medicine and surgery since 1983. Continuing this tradition, this fifth edition has been fully updated and revised to provide clear, didactic advice on best practice for a variety of clinical situations faced by practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice who see men with suboptimal fertility and reproductive problems. Completely restructured to include pedagogical features such as easily accessible key concepts that cement understanding and real-world use. Covering everything from foundations of anatomy and embryology, through clinical evaluation, diagnostic approaches, treatment and fertility care in context within the healthcare system and society, thrilling advances and future directions are also included. This new edition is an essential reference for all who are working in this young and rapidly evolving field.