By Peter Braude, Alison Taylor
Written via a group of infertility specialists, this advisor addresses the advanced topic of subfertility. It starts with analysis within the female and male earlier than featuring recommendation on all kinds of assisted belief in addition to counselling aid with therapy judgements.
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Additional resources for ABC of Subfertility (ABC Series)
In mild OHSS, without substantial pain or haemoconcentration, close monitoring and analgesia with advice to increase oral fluid intake should be sufficient management. Patients with moderate to severe OHSS should be admitted for anticoagulant prophylaxis and intravenous rehydration; if they also have a reduced urinary output or have marked distension or breathing difficulties they may require paracentesis or pleural fluid drainage. Presentation of OHSS Symptoms x Abdominal pain caused by enlarged ovaries and acute ascites x Abdominal distension secondary to enlarged ovaries and ascites x Feeling unwell, nauseated, vomiting x Bowel disturbance—can be constipation or diarrhoea x Dark, concentrated urine because of reduced renal perfusion and low urine output x Shortness of breath caused by splinting of diaphragm with marked ascites or pleural effusions x Leg and vulval oedema Timing x Early onset: within one to five days of human chorionic gonadotrophin injection, soon after egg collection and embryo transfer x Late onset: 7-14 days after embryo transfer when endogenous human chorionic gonadotrophin concentration rises after successful implantation Ultrasound scan showing an enlarged ovary (10 cm x 6 cm) and fluid in the pouch of Douglas and the uterovesical pouch Management of OHSS Grades of OHSS Mild x No need to admit x Increase oral fluid intake x Follow up at regular intervals and report if symptoms worsen Mild x Symptoms of abdominal discomfort and nausea x Ovarian enlargement between 5 cm and 12 cm Moderate x Admit to hospital and assess daily x Start thromboprophylaxis and maintain until patient is discharged x Monitor liver function, urea and electrolytes, full blood count, and clotting Severe x Strict fluid balance with input of 3 L or more.
With continuing improvements in cryopreservation and embryo culture there are moves to encourage the transfer of only one embryo at a time. 50 40 30 20 10 0 1940 1950 1960 1970 1980 1990 Year Triplet and other higher order births in England and Wales, 1938-97 Advantages of embryo cryopreservation x Maximises conception potential from an in vitro fertilisation or intracytoplasmic sperm injection stimulation cycle x Prevents wastage of any surplus embryos x Allows embryo transfer in a natural cycle with no risk of OHSS x Reduces the cost of treatment as gonadotrophins are not needed x No need for women receiving oocyte donation to synchronise their cycle with the donor injection, or frozen cycle.
The men withdrew their consent, however, and the embryos must now be destroyed. The High Court in London upheld the ruling that effective consent must be given by both the man and the woman to allow continued storage of their embryos General practitioners may find that, because of the strict confidentiality of the Human Fertilisation and Embryology Act, summaries and information about the assisted conception treatment that their patient is having may not be forthcoming if that is their patient’s wish.