IVF in the medically complicated patient : a guide to by Nick Macklon

By Nick Macklon

Each sufferer looking assisted replica has a special set of situations that has effects on the result of remedy. really hard are these sufferers with pre-existing health conditions or these receiving clinical treatments which could influence the security and luck in their IVF remedies. earlier identity and practise of the sufferer at elevated hazard of problems will let the clinician to prevent difficulties prematurely, expect the required administration, and optimize results. a brand new increased variation of the prize-winning textual content IVF within the Medically complex sufferer: A advisor to administration, moment version provides a effortlessly available, authoritative, and didactic resource of knowledge to assist clinicians during this very important field.

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Clinical outcome of preimplantation genetic diagnosis for cystic fibrosis: the Brussels’ experience. Eur J Hum Genet 2007;15:752–8. 59. Rechitsky S, Verlinsky O, Kuliev A. PGD for cystic fibrosis patients and couples at risk of an additional genetic disorder combined with 24-chromosome aneuploidy testing. Reprod Biomed Online 2013;26:420–30. 60. Epelboin S, Hubert D, Patrat C, et al. Management of assisted reproductive technologies in women with cystic fibrosis. Fertil Steril 2001;76:1280–1. Molgaard-Nielsen D, Pasternak B, Hviid A.

The classic triad of predisposing mechanisms described by Virchow – ­hypercoagulability, venous stasis and vascular damage – is still of value in understanding circumstances that may lead to DVT in the context of IVF. Ovarian stimulation results in a hyperestrogenic state, which has been associated with hypercoagulability and increased risk of DVT following oral contraceptive pill use and pregnancy. Evidence for estrogens as causes of thrombosis is provided by the reduction in the incidence of DVT associated with lower doses of estrogens in oral contraceptive pills.

9 The Patient at Risk from Thrombosis 25 While the mechanism behind thrombogenesis during OHSS is uncertain, the increased risk that arises in association with this complication of IVF is clear. Careful monitoring and the judicious use of measures to avoid OHSS are particularly important in patients at risk of thrombosis. In recent years a number of new strategies for reducing the incidence of OHSS have emerged. These include the use of GnRH antagonists rather than GnRH agonists to prevent premature luteinization, the use of GnRH agonists rather than hCG to trigger final oocyte maturation, the more liberal use of ‘freeze all’ cycles in which no fresh embryo transfer is carried out in the stimulated cycle, and the use of dopamine agonists to reduce symptoms.

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