Case Studies in Assisted Reproduction

Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning - all desirable generic skills for health care professionals. This volume contains a selection of cases on assisted reproduction that will inform and challenge reproductive medicine practitioners at all stages in their careers. Both common and uncommon cases are included. The aim is to reinforce diagnostic skill through careful analysis of individual presenting patterns, and to guide treatment decisions. Each case consists of a clinical history, examination findings and special investigations, before a diagnosis is made. Clinical issues raised by each case are discussed and major teaching points emphasized. Selective references are provided. The book provides a useful complementary adjunct to existing textbooks of reproductive medicine, and an excellent resource for teaching and continuing professional development.List of contributors; Preface; 1. Type 2 diabetes mellitus; 2. A woman with hypertension; 3. Increased risk of venous thromboembolism (VTE); 4. Assisted reproduction in a subfertile couple with serodiscordant HIV infection; 5. A woman with renal impairment; 6. A male with oligozoospermia and muscle weakness subsequently diagnosed with myotonic dystrophy; 7. Never say never to a Klinefelter patient; 8. A male with retrograde ejaculation; 9. A patient with severe lupus; 10. One partner is a carrier of thalassemia, one a carrier of sickle-cell anaemia; 11. A patient with Kallmann syndrome; 12. A patient with severe endometriosis needing IVF; 13. Recurrent miscarriage due to a balanced translocation: a case of PGS; 14. A patient found to have Cushing's syndrome; 15. Postpartum pituitary problems; 16. Large bilateral endometriomata; 17. A patient with a thin endometrium; 18. A poor responder; 19. Recurrent implantation failure; 20. Fertility preservation in an adolescent with Turner syndrome; 21. A young woman with a low AMH; 22. The patient who bleeds in the early luteal phase; 23. Threatened OHSS in a long GnRH agonist protocol; 24. An endometrial polyp detected during ovarian stimulation for IVF; 25. Fluid in the endometrial cavity during IVF treatment; 26. Tubal embryo transfer - a novel approach to manage difficult uterine access; 27. Mild-approach ART in a patient with polycystic ovary syndrome; 28. A slim patient with PCOS; 29. Recurrent cycles with retrieval of immature (GV) oocytes; 30. Think heterotopic; 31. A woman with an hydrosalpinx; 32. A PCOS patient with microprolactinoma, autoimmune thyroid disease and congenital thrombophilia; 33. IVF outcome in the same patient before and after myomectomy; 34. A patient with Factor XI deficiency and immune thrombocytopenia; 35. Abnormal cavity, abnormal fertility?; 36. A partner with 'flu; 37. Opting the day of final oocyte maturation, when 2 follicles are ready and 4 medium size follicles are following; 38. Late-onset ovarian hyperstimulation syndrome (OHSS); 39. The patient with recurrent poor embryo quality; 40. A high progesterone level during ovarian stimulation; 41. Repeated fertilization failure with normal sperm and MII oocytes; 42. A complete uterine septum: to treat or not to treat?; 43. Endometritis detected prior IVF; 44. LH rise on the day of GnRH antagonist commencement; 45. Controlled ovarian stimulation (COS) in women with normal ovarian reserve; 46. Errors in dosing medications; 47. Monozygotic triplets after single embryo transfer; 48. A teenager facing total body irradiation; 49. A 30-year-old with breast cancer; 50. A spontaneous pregnancy in Turner syndrome; 51. Fertility after conservative surgery for recurrent borderline ovarian tumour; 52. Successful pregnancy after radical trachelectomy and McDonald cerclage placement in a 42-year-old with invasive cervical adenocarcinoma; 53. Childbearing after conservative management of endometrial cancer; 54. Fertility preservation in a female of reproductive age with ovarian cancer; 55. Mother-daughter triplet surrogacy, 1987 world first; 56. Known sperm donation: helping siblings in family building; 57. A 5-year-old with pelvic rhabdomyosarcoma; 58. Co-fatherhood: same-sex male couple and IVF; Index.