Note:
This page refers to Dr. Silber’s 1998 book, “How to Get Pregnant with the New Technology”. In 2005, Dr. Silber published a completely revised and updated version of this classic book under the title, How to Get Pregnant , which lays out in clear, simple terms the basic information that will help couples understand their situation and achieve their goal – a happy, healthy baby.
Index | Table of Contents | Preface | Foreword to the Updated and Revised Edition
Contents from: “How to Get Pregnant with the New Technology: Updated and Revised Edition” , the bestselling book on infertility treatments and technology by Dr. Sherman J. Silber
FOREWORD to the updated and revised edition
PREFACE : The Infertility Epidemic
HOW DOES THE NEW TECHNOLOGY WORK?
SOLVING SEEMINGLY IMPOSSIBLE INFERTILITY PROBLEMS WITH THE NEW TECNOLOGY
Surrogate pregnancy
Egg donation
You can save your eggs for later
Congenital absence of sperm ducts
Micromanipulation: fertilization “by brute force”
Even men who don’t make sperm are fertile
TREATING COMMON INFERTILITY WITH THE NEW TECHNOLOGY
CONCLUSIONS
WHY ARE HUMANS SO INFERTILE?
HUMANS WERE NEVER REPRODUCTIVELY VERY EFFICIENT
WHY IS SEX IN THE HUMAN SO REPRODUCTIVELY INEFFICIENT?
SEASONAL TIMING OF SEX IN ANIMALS
THE NECESSITY OF A FAMILY SYSTEM IN HUMANS AND, THEREFORE, INFERTILITY
Reproductive inadequacy of the human male
WHY IS HUMAN SPERM COUNT SO POOR?
Is the environment causing our sperm count to go down?
Monogamy and lack of sperm competition
Evolution of male infertility
OUR WORLDWIDE INFERTILITY EPIDEMIC
HUMAN DESTINY AND INFERTILITY
SEXUALLY TRANSMITTED DISEASES
IS IN VITRO FERTILIZATION ETHICAL, AND SHOULD SOCIETY PAY FOR IT?
HOW YOU GET PREGNANT NORMALLY
A BRIEF INTRODUCTION TO THE VAGINA, UTERUS, TUBES, AND OVARIES
HOW DOES THE EGG REACH THE TUBE?
HOW DO SPERM REACH THE EGG?
Ejaculation to the vagina
Sperm invasion
Capacitation of sperm
OVULATION
Formation of the follicle
Release of the egg
Production of progesterone
HORMONES THAT CONTROL OVULATION AND THE MENSTRUAL CYCLE
HOW THE PRIMITIVE REGION OF THE BRAIN CALLED THE “HYPOTHALAMUS” CONTROLS THE MENSTRUAL CYCLE
CLINICAL IMPORTANCE OF GNRH RELEASE FROM THE BRAIN FOR IVF AND GIFT
FERTILIZATION OF THE EGG IN THE FALLOPIAN TUBE
HOW IS THE EGG PREPARED FOR FERTILIZATION DURING THE FOLLICULAR PHASE OF THE CYCLE UNDER FSH STIMULATION?
“REDUCTION DIVISION” (“MEIOSIS”) OF THE EGG’S CHROMOSOMES
DEVELOPMENT OF THE EGG DURING GROWTH OF THE FOLLICLE
RESUMPTION OF MEIOSIS AFTER THE LH SURGE
PENETRATION OF THE EGG BY A SPERM
COMPLETION OF MEIOSIS AND UNION OF THE MALE AND FEMALE GENES
EARLY DEVELOPMENT OF THE FERTILIZED EGG
PREGNANCY TESTING
FIGURING OUT WHAT’S WRONG
TESTS ON THE FEMALE
History and physical
Irregular periods and oily skin
Too fat or too thin
AM I OVULATING?
Basal Body Temperatures (BBT)
Examination of the cervical mucus during the monthly cycle
Blood hormone tests
The mid-cycle hormone surge
Effect of the “brain” on the hormonal cycle
Conclusions regarding hormones and ovulation
Endometrial biopsy
LH Dipstick
Ultrasound
LOOKING FOR STRUCTURAL ABNORMALITIES IN THE FEMALE
X-ray of uterus and tubes (“hysterosalpingogram”)
Laparoscopy
Idiopathic
HOW THE MALE WORKS
THE MALE MYTH
Causes of low sperm count
Internal structure of the testicles
Sperm production –the assembly line
What can be done to stimulate greater sperm production?
The reason we need so many sperm
Hormone testing for men
Variations in sperm count
HOW SPERM REACH THE EJACULATE
Leaving the testicles
What happens to sperm in the epididymis?
The fluid that squirts the sperm out
TESTICULAR TEMPERATURE
THE VARICOCELE DILEMMA
ARE SPERM THE PROBLEM? HOW MANY DO YOU NEED?
THE SPERM COUNT
What are sperm?
Does saving it up help?
How many sperm?
Motility of the sperm
The shape (morphology) of the sperm
The amount of semen
The appearance of the semen – liquid or jelly?
The chemistry of the semen
How many sperm are really necessary for a man to be fertile?
The hamster test
Sperm antibodies
WHOSE FAULT IS IT?
LOW SPERM COUNT DOES NOT MEAN IT’S THE “HUSBAND’S FAULT”
NOT REALLY THE “WIFE’S FAULT”
THE TRAGEDY OF NOT TREATING THE WHOLE COUPLE
LOW-TECH SOLUTIONS
HOW LONG DOES IT TAKE TO GET PREGNANT, OR WHEN DO WE KNOW TO LOOK FOR HELP?
Probability of conception per month in fertile couples
After what period of time does not getting pregnant mean we’re infertile?
PROPER TIMING OF INTERCOURSE
Position and method of intercourse
When to have intercourse
Basal Body Temperature charts
LH dipstick test
Daily transvaginal ultrasound
CLOMID (CLOMIPHENE CITRATE)
History of Clomid
How and when to take Clomid
BROMOCRIPTINE, OR “PARLODEL”
LUPRON, DANOCRINE, OR SURGERY, FOR ENDOMETRIOSIS
What is “endometriosis”?
Danocrine or Lupron for endometriosis
Surgery for endometriosis
SURGERY FOR BLOCKED TUBES AND PELVIC SCARRING
CONCLUSIONS
SPERM WASHING, INTRAUTERINE INSEMINATION (IUI), AND PERGONAL
SPERM WASHING
CAPACITATION
METHODS OF SPERM WASHING
Simple sperm wash with centrifugation
Swim-up technique
Migration technique
Percoll density gradient
INTRAUTERINE INSEMINATION (IUI) OF WASHED SPERM
The concept of IUI
Results with IUI (and Pergonal)
Timing the IUI
WHEN TO GIVE UP ON IUI (AND PERGONAL) AND GO TO GIFT OR IVF
OVARIAN STIMULATION WITH HMG (PERGONAL OR HUMEGON)
LUPRON TO PREVENT PREMATURE LH SURGE
HOW IS HMG MADE? WHAT IS IT?
Hyperstimulation syndrome
No increased risk of ovarian cancer
PREGNANCY AND MULTIPLE BIRTHS
MONITORING HMG OR FSH TREATMENT AND TIMING WHEN TO GIVE HCG
INDICATIONS FOR USING HMG
Directions my patients follow for HMG or FSH treatment
PROGESTERONE INJECTIONS
NORLUTATE FOR TIMING THE CYCLE
PREGNANCY TESTING
SUBSEQUENT PREGNANCIES WITHOUT TREATMENT
WHEN DO WE GO TO GIFT OR IVF?
IVF (IN VITRO FERTILIZATION) AND GIFT (GAMETE INTRA-FALLOPIAN TRANSFER)
INTRODUCTION
WHAT IS GIFT? ZIFT? IVF? ICSI ? HOW DO THEY DIFFER?
RATIONALE FOR DOING IVF OR GIFT IN ALL CASES OF INFERTILITY
STEP-BY-STEP DETAILS OF HOW “TEST-TUBE” BABIES ARE MADE
HORMONAL STIMULATION NECESSARY TO OBTAIN MORE THAN ONE EGG AND HORMONAL TIMING OF THE PROCEDURE
OBTAINING THE EGGS
PREPARATION OF THE SPERM
CULTURE TECHNIQUES FOR EGG AND SPERM
Culture media
CO2 incubator
Culture dishes and test tubes designed to keep pH constant when out of incubator
EFFECT OF pH ON SPERM
OSMOLALITY OF MEDIA
TEMPERATURE
PROTEIN
FILTERING
EGG HANDLING AFTER RETRIEVAL FROM OVARY
PLACING SPERM AND EGGS INTO THE FALLOPIAN TUBE FOR GIFT
ADDING THE SPERM TO THE EGGS, CULTURING FOR IVF, AND TRANSFER OF IN VITRO FERTILIZED EMBRYOS
EMBRYO FREEZING
SEVERE “MALE FACTOR”: FORMERLY THE BIGGEST PROBLEM IN REPRODUCTION
“Micromanipulation” of sperm
CONCLUSIONS
How do we pay for it?
What are my chances? And how do I decide where to go?
ICSI – THE LONG-SOUGHT SOLUTION TO MALE INFERTILITY
HOW THE ICSI TECHNIQUE WAS INVENTED
THE MEETING IN ADELAIDE
THE TYPE OF PATIENTS WHO NEED ICSI
ARE ALL TYPES OF MALE INFERTILITY EQUALLY TREATABLE WITH ICSI?
How do sperm normally fertilize an egg?
The role of the egg in normal fertilization
REASONS THAT SPERM INJECTION SHOULDN’T WORK
Damage to the egg nucleus and “spindle”
The membrane is invaginated by the injection pipette but not broken
Catching the sperm
Problem of the sperm swimming around inside the egg substance
STEP-BY-STEP DETAILS OF TE ICSI PROCEDURE
Step 1. Preparation of the eggs
Step 2. Preparation of the sperm
Step 3. Setting up the injection dish
Step 4. The pipettes used for injection
Step 5. Picking up the sperm, breaking the tail, and injecting it into the egg
Step 6. Checking for fertilization and cleavage
WHEN NOT TO DO ICIS FOR MALE INFERTILITY
SUCCESS USING ICSI IN EVERY TYPE OF MALE INFERTILITY: RELATIONSHIP TO AGE OF WIFE
THE GENETICS OF POOR SPERM PRODUCTION
USE OF ICSI FOR OLIGOSPERMIA
USE OF ICSI FOR AZOOSPERMIA (NO SPERM IN THE EJACULATE)
NON-OBSTRUCTIVE AZOOSPERMIA, OR ABSENCE OF SPERMATOGENESIS
ARE THE CHILDREN NORMAL?
THE GENETICS OF INFERTILE MEN ABOUT TO UNDERGO ICSI
OBSTRUCTION TO SPERM OUTFLOW–VASECTOMY REVERSAL AND OTHER SPERM BLOCKAGES
VASECTOMY REVERSAL AND MICROSURGERY
Why have a vasectomy reversal?
The “simple” microsurgical operation to “reconnect” the vas deferens
What has vasectomy done to the ducts of the testicles?
Duration of time since vasectomy
With “modern” vasectomies, the “blowouts” occur much sooner
How is the epididymal blockage bypassed?
Interpreting the results of the vasectomy reversal operation
Recovery of fertility after vasectomy reversal
Sperm antibodies
Does the wife always get pregnant after successful vasectomy reversal?
ICSI with retrieved sperm
OBSTRUCTION TO SPERM OUTFLOW IN PATIENTS WHO HAVE NOT HAD A VASECTOMY
Testicle biopsy
Vasograms
Microsurgical vasoepididymostomy
Congenital absence of the vas deferens
TESE-ICSI versus microsurgical vasoepididymostomy
GENETICS: WHO YOU ARE
A BASIC GENETICS LESSON
SEX-LINKED (OR X-LINKED) GENETIC DISEASE
GENETICS OF GETTING PREGNANT
How defective meiosis causes Down’s Syndrome and miscarriage
Evaluating embryo quality
PRE-IMPLANTATION EMBRYO BIOPSY
What is embryo biopsy?
FISH and PCR
Down’s Syndrome
Cystic Fibrosis
Muscular Dystrophy
THE FUTURE
CLONING
ARTIFICIAL INSEMINATION BY DONOR SPERM AND SPERM-BANKING
IS IT MY BABY?
MAKING THE ARRANGEMENTS AND SELECTING THE DONOR
AZOOSPERMIC VERSUS OLIGOSPERMIC HUSBAND
HOW IS IT DONE?
PREGNANCY RATES WITH DONOR SPERM
GIFT WITH DONOR SPERM
FROZEN SPERM AND SPERM BANKS
EGG DONATION AND SURROGATE UTERUS
SURROGATE UTERUS (YOUR MOTHER CAN HAVE YOUR KIDS FOR YOU)
EGG DONATION (YOU CAN GET PREGNANT AFTER MENOPAUSE)
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