| February 2007 · Vol. 19, No. 02 UPDATE
NEW DEVELOPMENTS THAT ARE CHANGING PATIENT CARE
FERTILITY
The state of the art in 5 key areas, with recommendations from ASRM and other experts
|
Fast Track
Failure to achieve pregnancy after 3 to 6 cycles of ovarian stimulation signals the need to expand evaluation or change treatment strategies
Because they reduce pregnancy rates by 50%, hydrosalpinges should be removed or the fallopian tube should be ligated proximally before IVF
A previous diagnosis or treatment for infertility increases the risk of recurrent pregnancy loss
Avoid hCG and intrauterine insemination if ultrasonography reveals more than 4 mature follicles (>15 mm) or 6 large follicles (>12 mm)
Preimplantation genetic diagnosis has been performed broadly to diagnose Tay-Sachs, Huntington’s disease, and other diseases that involve a single gene defect
For cancer patients, the preservation of ovarian tissue or oocytes yields pregnancy rates significantly lower than those observed with standard IVF
|
|
G.
David
Adamson,
MDDirector, Fertility Physicians of Northern California, Palo Alto and San Jose, Calif, Adjunct Clinical Professor, Stanford University, and Associate Clinical Professor, University of California San Francisco
Dr. Adamson is a past president of the Society for Assisted Reproductive Technology, the Society of Reproductive Surgeons, the Pacific Coast Reproductive Society, and the American Association of Gynecologic Laparoscopists (AAGL), and is President-elect of the American Society for Reproductive Medicine
The treatment of infertility has advanced rapidly over the past 25 years, thanks to technological developments and improved application of evidence-based clinical algorithms. Many tests and treatments that once were common no longer are, while rising in vitro fertilization (IVF) success rates and other laboratory procedures have transformed many aspects of management.
Changes are occurring so quickly it is often difficult for the general ObGyn to know the most advanced and appropriate treatment for a given patient. The American Society for Reproductive Medicine (ASRM) Practice Committee establishes guidelines based upon well-designed studies to help physicians keep abreast of the best clinical practices. In this article, I focus on recent ASRM guidelines in 5 topical areas associated with substantial misinformation in both the professional and public sectors:
|
