Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0059
S. Doumouchtsis
Pelvic floor disorders are strongly associated with childbirth and are more prevalent in parous women. Pelvic floor trauma commonly occurs at the time of the first vaginal childbirth. Conventionally, childbirth trauma refers to perineal and vaginal trauma following delivery and the focus has been on the perineal body and the anal sphincter complex. However, childbirth trauma may involve different aspects of the pelvic floor. Pelvic floor trauma during vaginal childbirth may involve tissue rupture, compression, and stretching, resulting in nerve, muscle, and connective tissue damage. Some women may be more susceptible to pelvic floor trauma than others due to collagen weakness. Childbirth trauma affects millions of women worldwide. The incidence of perineal trauma is over 91% in nulliparous women and over 70% in multiparous women. A clinical diagnosis of obstetric anal sphincter injury (OASIS) is made in between 1% and 11% of women following vaginal delivery. Increased training and awareness around OASIS is associated with an increase in the reported incidence. Short- and long-term symptoms of childbirth trauma can have a significant effect on daily activities, psychological well-being, sexual function, and overall quality of life.
{"title":"Childbirth trauma","authors":"S. Doumouchtsis","doi":"10.1093/med/9780198766360.003.0059","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0059","url":null,"abstract":"Pelvic floor disorders are strongly associated with childbirth and are more prevalent in parous women. Pelvic floor trauma commonly occurs at the time of the first vaginal childbirth. Conventionally, childbirth trauma refers to perineal and vaginal trauma following delivery and the focus has been on the perineal body and the anal sphincter complex. However, childbirth trauma may involve different aspects of the pelvic floor. Pelvic floor trauma during vaginal childbirth may involve tissue rupture, compression, and stretching, resulting in nerve, muscle, and connective tissue damage. Some women may be more susceptible to pelvic floor trauma than others due to collagen weakness. Childbirth trauma affects millions of women worldwide. The incidence of perineal trauma is over 91% in nulliparous women and over 70% in multiparous women. A clinical diagnosis of obstetric anal sphincter injury (OASIS) is made in between 1% and 11% of women following vaginal delivery. Increased training and awareness around OASIS is associated with an increase in the reported incidence. Short- and long-term symptoms of childbirth trauma can have a significant effect on daily activities, psychological well-being, sexual function, and overall quality of life.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131033869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0020
S. Nanda, J. Neilson
There has been a consistent rise in multiple pregnancies over recent years. Such pregnancies are at increased risk of miscarriage, fetal abnormalities, preterm birth, complications specific to shared placentation including twin-to-twin transfusion syndrome, selective growth restriction, and twin anaemia–polycythaemia sequence. In addition, a woman with a multiple pregnancy is at a higher risk of maternal complications including pre-eclampsia and other hypertensive disorders of pregnancy, obstetric cholestasis, gestational diabetes, exaggerated maternal pregnancy symptoms, and postpartum haemorrhage. Antenatal care in a multiple pregnancy should ideally be offered in a dedicated setting, with increased contact with the healthcare professionals compared to a singleton pregnancy. Such pregnancies, especially when complicated, need support and appropriate counselling to prepare for an optimal outcome.
{"title":"Multiple pregnancy","authors":"S. Nanda, J. Neilson","doi":"10.1093/med/9780198766360.003.0020","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0020","url":null,"abstract":"There has been a consistent rise in multiple pregnancies over recent years. Such pregnancies are at increased risk of miscarriage, fetal abnormalities, preterm birth, complications specific to shared placentation including twin-to-twin transfusion syndrome, selective growth restriction, and twin anaemia–polycythaemia sequence. In addition, a woman with a multiple pregnancy is at a higher risk of maternal complications including pre-eclampsia and other hypertensive disorders of pregnancy, obstetric cholestasis, gestational diabetes, exaggerated maternal pregnancy symptoms, and postpartum haemorrhage. Antenatal care in a multiple pregnancy should ideally be offered in a dedicated setting, with increased contact with the healthcare professionals compared to a singleton pregnancy. Such pregnancies, especially when complicated, need support and appropriate counselling to prepare for an optimal outcome.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128482930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0056
S. Rachaneni, A. Dua, R. Freeman
Pelvic organ prolapse is a departure from normal sensation, structure, or function, experienced by the woman in reference to the position of her pelvic organs. Symptoms such as the feeling of a bulge, vaginal heaviness, or ‘something coming down’, are generally worse after long periods of standing or exercise and better when lying supine. Other symptoms include bladder, bowel, and sexual dysfunction. Prolapse may be more prominent with a full bladder and/or rectum and at times of abdominal straining, for example, defecation. Pelvic organ prolapse is not just a problem in older women and represents a health economic challenge for the future due to the costs of surgery, the longer life expectancy, and an increasing demand for a better quality of life.
{"title":"Pelvic organ prolapse","authors":"S. Rachaneni, A. Dua, R. Freeman","doi":"10.1093/med/9780198766360.003.0056","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0056","url":null,"abstract":"Pelvic organ prolapse is a departure from normal sensation, structure, or function, experienced by the woman in reference to the position of her pelvic organs. Symptoms such as the feeling of a bulge, vaginal heaviness, or ‘something coming down’, are generally worse after long periods of standing or exercise and better when lying supine. Other symptoms include bladder, bowel, and sexual dysfunction. Prolapse may be more prominent with a full bladder and/or rectum and at times of abdominal straining, for example, defecation. Pelvic organ prolapse is not just a problem in older women and represents a health economic challenge for the future due to the costs of surgery, the longer life expectancy, and an increasing demand for a better quality of life.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125343804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0047
Stephanie S. Andriputri, S. D. Lyons, J. Abbott
A minimal access approach has been one of the most substantial changes to surgery in the last century with most specialties recognizing the endoscopic technique as one that reduces patient morbidity, improves postoperative recovery, and may reduce costs associated with healthcare delivery. In gynaecological laparoscopy, all surgical procedures may be undertaken by this method, although approaches vary and the evidence for individual techniques is qualitatively disparate. Whenever possible, it is recommended that an evidence-based practical application of surgery be followed and this chapter considers the evidence about gynaecological laparoscopy. It will follow options for managing the laparoscopy patient, rather than focusing on individual procedures. The evidence will be addressed according to both quality and volume. It is outside of the scope to consider all possible surgical techniques and the chapter appraises the various aspects of care that are common to gynaecological laparoscopy in a logical and sequential manner.
{"title":"Laparoscopy","authors":"Stephanie S. Andriputri, S. D. Lyons, J. Abbott","doi":"10.1093/med/9780198766360.003.0047","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0047","url":null,"abstract":"A minimal access approach has been one of the most substantial changes to surgery in the last century with most specialties recognizing the endoscopic technique as one that reduces patient morbidity, improves postoperative recovery, and may reduce costs associated with healthcare delivery. In gynaecological laparoscopy, all surgical procedures may be undertaken by this method, although approaches vary and the evidence for individual techniques is qualitatively disparate. Whenever possible, it is recommended that an evidence-based practical application of surgery be followed and this chapter considers the evidence about gynaecological laparoscopy. It will follow options for managing the laparoscopy patient, rather than focusing on individual procedures. The evidence will be addressed according to both quality and volume. It is outside of the scope to consider all possible surgical techniques and the chapter appraises the various aspects of care that are common to gynaecological laparoscopy in a logical and sequential manner.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114918885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0011
A. P. Carrillo, A. Bhide
Prenatal diagnosis commenced in the 1980s as part of routine antenatal care in the United Kingdom. Ultrasonography has become widely spread and the main tool to screen for fetal structural abnormalities and chromosomal defects together with biochemical markers. Standardization of routine antenatal screening has only been introduced recently by the National Health Service Fetal Anomaly Screening Programme (FASP) in an attempt to achieve uniformity in prenatal diagnosis around the country. A series of recommendations were made including 11 fetal conditions with a detection rate of more than 50% that should be routinely screened for in any centre in the country. Any ultrasound scan should be performed in a systematic fashion ensuring examination of every system in the fetal anatomy. It is essential to become familiarized with the normal fetal anatomy and the most common structural abnormalities and referral to a centre with appropriate expertise is imperative if any abnormality is suspected.
{"title":"Prenatal diagnosis","authors":"A. P. Carrillo, A. Bhide","doi":"10.1093/med/9780198766360.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0011","url":null,"abstract":"Prenatal diagnosis commenced in the 1980s as part of routine antenatal care in the United Kingdom. Ultrasonography has become widely spread and the main tool to screen for fetal structural abnormalities and chromosomal defects together with biochemical markers. Standardization of routine antenatal screening has only been introduced recently by the National Health Service Fetal Anomaly Screening Programme (FASP) in an attempt to achieve uniformity in prenatal diagnosis around the country. A series of recommendations were made including 11 fetal conditions with a detection rate of more than 50% that should be routinely screened for in any centre in the country. Any ultrasound scan should be performed in a systematic fashion ensuring examination of every system in the fetal anatomy. It is essential to become familiarized with the normal fetal anatomy and the most common structural abnormalities and referral to a centre with appropriate expertise is imperative if any abnormality is suspected.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134316989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0044
J. Chung, T. Li
Chronic pelvic pain (CPP) is a common gynaecological complaint with a similar consultation rate to low back pain, asthma, or migraine. It is estimated that up to 15–20% of women aged 18–50 years have experienced CPP for more than 1 year. Nevertheless, the incidence of CPP is likely to be underestimated due to under-reporting. CPP is a condition distressing to patients and challenging to gynaecologists. It is commonly associated with endometriosis, adhesions, pelvic inflammatory disease, as well as a variety of urological, gastrointestinal, musculoskeletal, or psychosocial conditions. This chapter provides a general overview of the condition, with a special emphasis on the management strategy in dealing with patients with this condition.
{"title":"Chronic pelvic pain","authors":"J. Chung, T. Li","doi":"10.1093/med/9780198766360.003.0044","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0044","url":null,"abstract":"Chronic pelvic pain (CPP) is a common gynaecological complaint with a similar consultation rate to low back pain, asthma, or migraine. It is estimated that up to 15–20% of women aged 18–50 years have experienced CPP for more than 1 year. Nevertheless, the incidence of CPP is likely to be underestimated due to under-reporting. CPP is a condition distressing to patients and challenging to gynaecologists. It is commonly associated with endometriosis, adhesions, pelvic inflammatory disease, as well as a variety of urological, gastrointestinal, musculoskeletal, or psychosocial conditions. This chapter provides a general overview of the condition, with a special emphasis on the management strategy in dealing with patients with this condition.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133277145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0053
Z. van der Spuy, P. Steyn
Effective contraception is central to reproductive health and unintended pregnancies have a major negative impact on both maternal and child health. It is recognized that there is a global unmet need for effective contraception and often the unplanned pregnancy is terminated, sometimes by unsafe practices. There is recognition of the importance of accessible, effective fertility regulation both in the Millennium Development Goal 5b and now in Sustainable Development Goal 3. It is hoped that contraceptive provision will be expanded and made accessible to many women who previously were not able to address their fertility needs. The World Health Organization offers input and excellent clinical advice through the Medical Eligibility Criteria for contraceptive use which are regularly updated. It is recommended that these should be adapted for local use where appropriate. An understanding of the success of contraceptive methods with typical rather than perfect use is central to advising women and their partners on their contraceptive options. Attention to women with special needs such as those with medical disorders, young women, and women living with HIV must be central to any contraceptive service. Counselling should include discussing the risks and benefits of appropriate methods, the availability of emergency contraception, and the ongoing access to contraceptive counselling and reproductive health services. The aim of contraceptive service provision is to avoid unintended pregnancies and ensure that women feel empowered in the choices they make. Services providers are encouraged to provide a spectrum of contraceptive options which are accessible and acceptable to all clients.
{"title":"Contraception","authors":"Z. van der Spuy, P. Steyn","doi":"10.1093/med/9780198766360.003.0053","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0053","url":null,"abstract":"Effective contraception is central to reproductive health and unintended pregnancies have a major negative impact on both maternal and child health. It is recognized that there is a global unmet need for effective contraception and often the unplanned pregnancy is terminated, sometimes by unsafe practices. There is recognition of the importance of accessible, effective fertility regulation both in the Millennium Development Goal 5b and now in Sustainable Development Goal 3. It is hoped that contraceptive provision will be expanded and made accessible to many women who previously were not able to address their fertility needs. The World Health Organization offers input and excellent clinical advice through the Medical Eligibility Criteria for contraceptive use which are regularly updated. It is recommended that these should be adapted for local use where appropriate. An understanding of the success of contraceptive methods with typical rather than perfect use is central to advising women and their partners on their contraceptive options. Attention to women with special needs such as those with medical disorders, young women, and women living with HIV must be central to any contraceptive service. Counselling should include discussing the risks and benefits of appropriate methods, the availability of emergency contraception, and the ongoing access to contraceptive counselling and reproductive health services. The aim of contraceptive service provision is to avoid unintended pregnancies and ensure that women feel empowered in the choices they make. Services providers are encouraged to provide a spectrum of contraceptive options which are accessible and acceptable to all clients.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132844063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0027
V. Talaulikar, S. Arulkumaran
The process of labour and delivery can be a hazardous journey for the fetus. The principal aim of monitoring a fetus during labour is to detect changes in the fetal heart rate that suggest a possibility of fetal hypoxia and metabolic acidosis so that timely action can be taken to prevent adverse outcomes. For the last four decades, intrapartum monitoring of fetuses has been commonly performed by either intermittent auscultation or electronic fetal heart rate monitoring (EFM). While intermittent auscultation has been the method of choice in low-risk pregnancies and in settings with limited resources, continuous EFM by cardiotocography has formed the mainstay of fetal surveillance in high-risk pregnancies in most of the high-resourced countries. The terminology, classification, and threshold for intervention with the use of EFM are discussed and adjunct technologies that support the use of EFM are also considered.
{"title":"Fetal monitoring during labour","authors":"V. Talaulikar, S. Arulkumaran","doi":"10.1093/med/9780198766360.003.0027","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0027","url":null,"abstract":"The process of labour and delivery can be a hazardous journey for the fetus. The principal aim of monitoring a fetus during labour is to detect changes in the fetal heart rate that suggest a possibility of fetal hypoxia and metabolic acidosis so that timely action can be taken to prevent adverse outcomes. For the last four decades, intrapartum monitoring of fetuses has been commonly performed by either intermittent auscultation or electronic fetal heart rate monitoring (EFM). While intermittent auscultation has been the method of choice in low-risk pregnancies and in settings with limited resources, continuous EFM by cardiotocography has formed the mainstay of fetal surveillance in high-risk pregnancies in most of the high-resourced countries. The terminology, classification, and threshold for intervention with the use of EFM are discussed and adjunct technologies that support the use of EFM are also considered.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132066752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0009
E. Jauniaux, A. Bhide, G. Burton
Abnormal placental development and function are widely recognized as having immediate consequences on the outcome of a pregnancy, and more recently to influence the lifelong health of the offspring. The development of the placenta starts from implantation, when the embryonic pole of the blastocyst enters into contact with the maternal uterine epithelium. The placenta provides the fetus with all essential nutrients, water, and oxygen, and a route for clearance of fetal excretory products, but it also produces a vast array of protein and steroid hormones and factors necessary for the maintenance of pregnancy. Placental-related disorders of pregnancy affect around a third of human pregnancies, primarily including miscarriages, pre-eclampsia, and fetal growth restriction. Placental and umbilical cord structural anomalies that are associated with perinatal complications can now be diagnosed from early in pregnancy with ultrasonography and the antenatal detection of anomalies such as placenta praevia and placenta accreta has a direct impact on the outcome of pregnancy.
{"title":"The placenta","authors":"E. Jauniaux, A. Bhide, G. Burton","doi":"10.1093/med/9780198766360.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0009","url":null,"abstract":"Abnormal placental development and function are widely recognized as having immediate consequences on the outcome of a pregnancy, and more recently to influence the lifelong health of the offspring. The development of the placenta starts from implantation, when the embryonic pole of the blastocyst enters into contact with the maternal uterine epithelium. The placenta provides the fetus with all essential nutrients, water, and oxygen, and a route for clearance of fetal excretory products, but it also produces a vast array of protein and steroid hormones and factors necessary for the maintenance of pregnancy. Placental-related disorders of pregnancy affect around a third of human pregnancies, primarily including miscarriages, pre-eclampsia, and fetal growth restriction. Placental and umbilical cord structural anomalies that are associated with perinatal complications can now be diagnosed from early in pregnancy with ultrasonography and the antenatal detection of anomalies such as placenta praevia and placenta accreta has a direct impact on the outcome of pregnancy.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123712072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0052
William J. Ledger
In vitro fertilization (IVF) has become the predominant treatment for almost all forms of male and female infertility and has resulted in the birth of more than 7 million children. IVF leads to more than 3% of all births in some developed countries although access to this technology is mainly restricted to the West. Although the basic principles of ovarian stimulation, oocyte collection, fertilization in vitro, embryo transfer, and luteal phase support remain the same, modern technology and improved laboratory and clinical practices have led to significant improvements in the likelihood of pregnancy after IVF for many couples. Advanced female age remains the main factor that reduces chances of pregnancy after IVF although oocyte and embryo freezing offer solutions for some. The science of assisted reproductive technology continues to advance rapidly and is increasingly applied to couples who are not infertile but who wish to access the DNA of their potential offspring for advanced genetic testing. This technology will be more widely applied in years to come.
{"title":"Assisted reproduction","authors":"William J. Ledger","doi":"10.1093/med/9780198766360.003.0052","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0052","url":null,"abstract":"\u0000 In vitro fertilization (IVF) has become the predominant treatment for almost all forms of male and female infertility and has resulted in the birth of more than 7 million children. IVF leads to more than 3% of all births in some developed countries although access to this technology is mainly restricted to the West. Although the basic principles of ovarian stimulation, oocyte collection, fertilization in vitro, embryo transfer, and luteal phase support remain the same, modern technology and improved laboratory and clinical practices have led to significant improvements in the likelihood of pregnancy after IVF for many couples. Advanced female age remains the main factor that reduces chances of pregnancy after IVF although oocyte and embryo freezing offer solutions for some. The science of assisted reproductive technology continues to advance rapidly and is increasingly applied to couples who are not infertile but who wish to access the DNA of their potential offspring for advanced genetic testing. This technology will be more widely applied in years to come.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127488595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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