Recent advances in medically assisted conception : report of a WHO scientific group [meeting held in Geneva from 2 to 6 April 1990]

Abstract

A state-of-the-art summary of procedures used in medically assisted conception, emphasizing what is known about the medical indications for specific procedures, their safety, and the factors influencing their success. Procedures covered include in vitro fertilization, gamete intrafallopian transfer, and similar procedures, as well as established techniques for artificial insemination by the husband or a donor. Addressed to the managers of programmes for the treatment of infertility, the book makes a special effort to distinguish procedures of demonstrated efficacy from those whose potential advantages remain to be confirmed. More than 600 references to the literature are included. Background information is provided in the opening sections, which outline the most common causes of infertility and summarize the historical development of current techniques for investigation and treatment. Subsequent sections address the need to reduce the psychological stress linked to infertility and its treatment, and describe fundamental ethical principles that should govern programmes for medically assisted conception, particularly concerning protection of the human embryo and the use of uman genetic material. Advances in in vitro fertilization are covered in five sections. Information includes an outline of the medical indications for treatment, followed by discussions of the procedures and preferred protocols for the induction of multiple follicular development, for oocyte fertilization and subsequent embryo culture, and for intrauterine and intrafallopian transfer. Details range from instructions for the checking, maintenance and cleaning of laboratory items to a discussion of the dilemma created by the introduction of drug regimens that induce multiple follicular development and permit the harvest of numerous oocytes. Results of in vitro fertilization, embryo transfer and related procedures are also reviewed in an effort to identify the many factors affecting success rates. Artificial insemination is covered in three sections, which offer advice on the collection, storage and preparation of donor semen, outline indications and techniques, and provide guidance on the assessment of results. The remaining sections identify requirements for personnel, equipment, and quality assurance, as well as for future research in such areas as sperm abnormalities, oocyte quality, embryo culture, and cryopreservation