Human Blastocysts In In Vitro Fertilisation

The field of human artificial reproductive technology (ART) is continually advancing and has witnessed significant changes since the inception of Louise Brown in 1978. Though Louise Brown herself was conceived after the trans fer of a blastocyst, there remain significant confusion and debate regarding the stage at which the human embryo conceived in the laboratory should be replaced in the mother. Developments in culture media formulations, leading to the introduction of sequential media, have brought the role of the blasto cyst in human ART back into the spotlight. It was due to this resurgence of interest in the niche of extended culture in human infertility treatment that the symposium on "ART and the Human Blastocyst" was held. of this meeting within this volume bring to the forefront The proceedings the main issues raised with the transfer of embryos at the blastocyst stage. It is evident from the chapters that follow that ART needs to be perceived as a continuum of procedures, each one dependent on the preceding one, and all equally as important as each other. That is to say, the development of a com petent embryo is ultimately dependent on the quality of the gametes from which it was derived. With regard to the oocyte, this then places the emphasis on the physician to use a stimulation protocol that both produces quality oocytes and does not impair endometrial function. Maintenance of gamete and embryo quality is the laboratory's role.

Providing information from the cutting edge of reproductive technology, this full-color atlas vividly illustrates the typical and atypical morphology of human blastocysts collected and cultured during the course of in vitro fertilization treatments. The narrative and the illustrations detail a variety of new reproductive technologies. All photographs are supported by detailed legends and a glossary of terms is included. This atlas is edited by two world-class embryologists both of whom work at the Center for Reproductive Medicine and Infertility at the Weill Medical College of Cornell University.

The use of human in vitro fertilization in the management of infertility is the outgrowth of years of laboratory observations on in vitro sperm-egg interaction. "The editors of this work have themselves contributed significantly to basic knowledge of the mammalian fertilization process. The observations of Don Wolf on sperm penetration, the block to polyspermy and, most recently, sperm hyperactivation in the monkey and human, Gregory Kopf's elucidation of the mechanisms of sperm activation during penetration and the reciprocal dialogue between sperm and egg, and Barry Bavister's definition of culture conditions and requirements necessary for in vitro oocyte maturation, fertilization and development in model mammalian systems including nonhuman primates have contributed greatly to our understanding of the mammalian fertilization process. Wolf, Kopf and Gerrity have enjoyed substantial interaction with clinicians in Departments of Obstetrics and Gynecology and have been directly involved with successful IVF programs. Both Wolf and Kopf have served as research scientists in the Division of Reproductive Biology at the University of Pennsylvania, which, for more than 22 years, has fostered co-mingling of clinically oriented and basic science faculty. It is through such interaction, which clearly exists at many institutions including the University of Wisconsin, that the process of technology transfer is best served. Without an exquisitely coordinated laboratory, there can be no consistent success in human in vitro fertilization. Quality control is pivotal, but close collaboration between the laboratory and the clinic is also essential as information is shared and correlated.

This volume contains the Proceedings of the Serono Symposium on Pre implantation Embryo Development, held in Newton, Massachusetts, in 1991. The idea for the symposium grew out of the 1989 Serono Symposium on Fertilization in Mammals* at which preimplantation development was the predominant suggestion for a follow-up topic. This was indeed a timely subject in view of the recent resurgence of interest in this funda mental phase of embryogenesis and its relevance to basic research and applied fertility studies in humans, food-producing animals, and endangered species. The symposium brought together speakers from a broad range of disciplines in order to focus on key regulatory mechanisms in embryo development, using a wide variety of animal models, and on representative topics in human preimplantation embryogenesis. The culmination of preimplantation development is a blastocyst con taining the first differentiated embryonic tissues and capable of initiating and sustaining pregnancy. The central objective of the symposium was to throw light on the regulation of cellular and molecular events underlying blastocyst formation. It was particularly appropriate that the date of the symposium marked the 20th anniversary of the publication of the classic volume Biology of the Blastocyst, the proceedings of an international workshop held in 1970. This book, which summarized most of the information then available on this topic in mammals, was edited by the pioneer in blastocyst research, Dr. Richard B1andau, who was the guest speaker at the symposium.

In recent years, the advancing science and increasing availability of assisted reproduction have given new hope to infertile couples. However, the use of IVF and ART has also led to marked increases in the number of multiple-infant live births. This poses a public health concern, as these neonates have a higher rate of pre-term delivery, compromising their survival chances and increasing their risk of lifelong disability. By optimizing the selection of gametes and embryos with high probabilities of implantation, it is possible to reduce the number of embryos transferred and, by extension, the number of high-risk multiple gestations, while maintaining or increasing pregnancy rates. Human Gametes and Preimplantation Embryos: Assessment and Diagnosis provides a broad yet concise overview of established and developing methodologies for assessment of gamete and embryo viability in assisted reproduction. This book elucidates the best practices for precisely selecting viable specimens based on morphology and cleavage rate and covers the spectrum of emerging adjunctive technologies for predicting reproductive potential. The authors present their extensive knowledge of “omics” approaches (genomics, transcriptomics, proteomics, and metabolomics), with unbiased delineation of the associated advantages and potential pitfalls. This valuable clinical resource is well suited to infertility specialists, Ob/Gyn physicians, IVF laboratory technicians, and researchers in the fields of embryology and reproductive medicine.

While the organization of an international congress on in vitro fertilization (IVF) was an entirely new venture for us in 1983, since we had no experience but were full of optimism, we approached the organization of a second Congress in Vien na in 1986 much more calmly. Our experience had increased as had the readiness of many of our friends to help and of people interested in cooperating. However, would our Congress not lose its originality on account of the increased routine? This was certainly a possible danger which we wanted to prevent by means of two counter measures. The first concerned the scientific program: the new and trend-setting aspects of IVF would be discussed primarily rather than the results of traditional methods. The second measure concerned the social program, aimed more at private contacts in the intimate and familiar atmosphere of homes and workplace rather than meetings in luxurious but impersonal public institu tions. We believe that both these measures achieved the desired effect. Although we could not avoid some events taking place at the same time, the most important problems were treated and discussed jointly. Thus, the Congress was easy to survey, and all topics were thoroughly discussed.

The new edition of this text admirably fills the need for a primer on the central topics involved in Human In Vitro Fertilization (IVF). Supplying a comprehensive and hands-on approach to IVF, this source presents established state-of-the-art procedures and techniques, as well as the most current research in the field. Expert contributors also discuss the history of IVF and the potential of future research. Offering essential information for reproductive endocrinologists, IVF practitioners and embryologists, this book guides readers though every step of human assisted conception, from patient pre-treatment to monitoring of outcomes.

This book provides updates on the most recent developments in individualized infertility treatment resulting in improved outcomes.