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40 - IVF in the Medically Complicated Patient

from PART III - ASSISTED REPRODUCTION

Published online by Cambridge University Press:  04 August 2010

By
Botros R. M. B. Rizk ,
Christopher R. Rizk ,
Sameh Mikhail ,
Christine B. Rizk ,
Hany F. Moustafa ,
James Hole ,
Sheri Owens ,
Susan Baker  and
Kathy B. Porter
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

The majority of women undergoing assisted reproduction are healthy and relatively young. However, the tendency to delay pregnancy to later on in life may mean that some of the patients may present with a concurrent condition that may have implications for in vitro fertilization (IVF), pregnancy, and its outcome. Preparing the couple for pregnancy is an important task, which the infertility specialist has to undertake.

Some of the important issues that may be challenging to the clinician are medical problems that affect a variety of systems. With the increasing survival of cancer patients, many patients are not only satisfied with their cure but are also eager to fulfill their reproductive potential. The patient with endocrine problems such as hyperprolactinemia and hypopituitarism, Cushing's syndrome, and diabetes mellitus have to be addressed prior to assisted conception couples that are discordant for human immunodeficiency virus (HIV) present their own challenge regarding infertility treatment. Couples with sexual dysfunction may also present for assisted conception. Finally, patients at risk for thrombosis could pose tremendous challenges during assisted reproduction treatment and a subsequent pregnancy as discussed in the chapter 45.

Some patients present with gynecologic problems that are either challenging or that impact the IVF outcome. Patients with endometriosis exemplify this scenario as discussed in the chapter 42. Patients with fibroids and hydrosalpynx require surgical treatment prior to IVF as discussed in the chapter 39.

Keywords

cancer patientscontrolled ovarian hyperstimulationhigh-risk pregnanciesHIV discordant couplesobesitypregnancysystemic lupus erythematosusin vitro fertilization
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 371 - 374
Publisher: Cambridge University Press
Print publication year: 2008

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References

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