TAILIEUCHUNG - Monitoring In Vitro Fertilization Outcome

In this chapter, I will provide insights into the following areas of in vitro fertilization outcome. First, why we monitor in vitro fertilization (IVF) outcome. Second, why monitoring IVF outcome is not well done. Third, a brief overview of the known IVF literature. Fourth, how to do monitoring in an ideal world, and what outstanding questions have not been addressed which are of concern to families, fertility practitioners, the broader scientific community, and general public. WHY MONITOR IVF OUTCOME? The first generation of assisted reproductive technology (ART)-conceived children are now growing up and ART practice has changed much during. | _21 Monitoring In Vitro Fertilization Outcome Alastair G. Sutcliffe Department of Community Child Health Royal Free and University College Medical School and University College London London . INTRODUCTION In this chapter I will provide insights into the following areas of in vitro fertilization outcome. First why we monitor in vitro fertilization IVF outcome. Second why monitoring IVF outcome is not well done. Third a brief overview of the known IVF literature. Fourth how to do monitoring in an ideal world and what outstanding questions have not been addressed which are of concern to families fertility practitioners the broader scientific community and general public. WHY MONITOR IVF OUTCOME The first generation of assisted reproductive technology ART -conceived children are now growing up and ART practice has changed much during this period. The initial method of IVF has been supplemented by embryo cryopreservation and more recently by intracytoplasmic sperm injection ICSI . Following on from these procedures trans epididimal sperm aspiration TESA and testicular biopsy have resulted in a less naturally selective form of reproduction. These developments and also such things as extended culture blastocyst transfers etc. are often used without explicit 465 466 Sutcliffe consideration of the risks for the child. However several positive practice developments are underway now including a genuine effort underpinned by legislation to reduce the risk of higher-order births still the main risk to children born after ART and efforts to consider the well-being of the child more formally from the start of new therapies. For example I have been involved recently as an advisor on a confidential trial which investigates the efficacy of a treatment to enhance embryo implantation. The study designers from the outset asked advice on how to assess the health of any children born after successful pregnancies both at birth and

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