How to Get Pregnant with the New Technology – Contents | Dr. Silber

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
  • Early difficulties with IVF (In Vitro Fertilization)
  • GIFT (Gamete Intra-Fallopian Transfer) popularized the new reproductive technology
  • So where do we go for help?
• 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?
  • Assisted Hatching
  • Explanation for pregnancy rates
• RATIONALE FOR DOING IVF OR GIFT IN ALL CASES OF INFERTILITY
  • Go to IVF or GIFT sooner

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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