In this chapter, women’s expectations and plans for motherhood are followed, using qualitative, longitudinal interview data collected in the UK between 2017 and 2019. Their narrations are compared to key experiences from the original motherhood study conducted 21 years earlier. In both motherhood studies, familiarity with normative constructions of ‘good’ motherhood is apparent well before pregnancy. But in the contemporary study, these are now also informed by limitless digital resources, such as social media platforms, forums and applications (apps). The average age for first-time motherhood in the UK has increased so that women have longer established work biographies and career histories before experiencing maternal subjectivity. In this antenatal period, the women draw upon strands of different discourse to narrate pregnancy and their preparations for motherhood, including managing a pregnant body, plans for birth and a return to the workplace. Generational changes are also invoked, alongside hopes that grandparents will help fill anticipated childcare gaps, easing the financial burden of working parenthood. The discourse of ‘balance’ and ‘balancing work and family life’ is used to describe plans for managing working motherhood/parenthood, which either seem possible from this pre-baby vantage point or, for some, are already provoking a sense of anxiety.

In this chapter, we will review how men’s health has evolved into a distinct subspecialty of medicine and changed over the past two decades. There exists a large disparity between men and women when it comes to health. However, as the drivers for men seeking health care are changing, the urologist is in a unique position to help quarterback men’s health initiatives. Men’s health advocacy and the creation of men’s health centers are on the rise. Areas of advancement in the field include prostate cancer diagnosis and treatment, erectile dysfunction therapies, surgical treatment for chronic testicular pain, and new approaches to male factor infertility. The burgeoning field of men’s health has seen many advancements in the past two decades and will continue to make significant gains in the years to come.

In nature varying strategies are used to ensure that the best sperm arrives at the egg. Strategies to select the best sperm are far less rigorous in the setting of in vitro fertilization. In this chapter we discuss how in vitro sperm selection strategies utilize different components of the spermatozoon including their motility characteristics, size, membrane properties, and nuclear structure. Sperm selection strategies have included microfluidics, spectroscopy, label-free imaging, hyaluronan binding, and separation of sperm by charge. Although some studies have shown that sperm selection can improve embryo euploidy rates and pregnancy outcomes, in particular by reducing miscarriages, large clinical trials, focused on the male population who would benefit most from sperm selection, are still needed.

This chapter briefly introduces microfluidics as an enabling technology for medicine, focusing on microfluidic-enabled treatments for male infertility. The first section provides a brief overview of microfluidics-based applications in biomedical research and assisted reproductive technology (ART). In the following sections, we review notable demonstrations of microfluidic technology applied to sperm sample preparation and sperm identification. Finally, we conclude the chapter by providing our perspective on the application of microfluidics technology for male infertility treatment, and the challenges/opportunities for further growth of microfluidics-enabled ART for male infertility.

The quality of selected spermatozoa is crucial for the success of assisted reproduction. However, selecting the “best sperm” from an ejaculate or surgically retrieved sample remains challenging. In this chapter, we have reviewed conventional, advanced, and emerging sperm selection techniques, including the most up-to-date reliable evidence-based resources, with emphasis on sperm selection methods and clinical outcomes. Current selection techniques are manual and prone to subjective judgment or experience and effort of laboratory personnel. Despite the large number of publications, the available evidences are not sufficient to support any specific sperm selection technique. The only unanimous agreement thus far is that well-designed, large-scale, sufficiently powered randomized controlled studies are required to evaluate sperm selection techniques; these may include personalized sperm selection, machine learning, and robotics strategies aimed at improving outcomes of assisted reproduction.

From a practical point of view, the culmination of excellent work in the IVF laboratory is the perfect transfer of the right embryos to the right part of the uterine cavity, aseptically and safely. As with all other tasks in the IVF laboratory, embryologists need to gain experience with embryo transfer (ET) techniques. Embryo loading in the different types of ET catheters, compared to ICSI or embryo biopsy, seems a fairly straightforward procedure but involves a great deal of responsibility. Excellent communication with doctors during ET, good embryo loading technique, training and proper traceability are key elements that will provide the quality needed for this simple but important step in assisted reproductive treatments.

Optimization of procedures routinely performed in a clinical human in vitro fertilization (IVF) laboratory have become increasingly important due to the increase in complexity of procedures now performed in the laboratory. The addition of new technologies requiring more oversight has increased dramatically within the last decade. As a result of incorporating these new technologies, safe and efficient operation of the IVF laboratory has become increasingly complex and requires a substantial understanding of processes within the laboratory. In today’s modern IVF laboratory, the amount of staff time to perform every increasingly complicated case has more than doubled. Similarly, the amount required time to prepare for these cases has increased dramatically as well. In many instances, the increase in complexity of laboratory procedures has not translated into hiring of new staff but the creation of challenges to improve efficiency within the laboratory. The current guidelines for allocation of staff are based upon cycle numbers performed on an annual basis, not complexity of cases performed.

Scientists working in IVF laboratories come from varied backgrounds with a myriad of different educational experiences. Rarely are there local or national requirements which dictate the education or training needed; however, at a minimum, any aspiring embryologist will have an undergraduate degree with emphasis in biology and chemistry. A degree in laboratory sciences may offer many desirable, general laboratory skills, while an advanced degree, Masters or PhD in clinical embryology or reproductive sciences will give the scientist a stronger theoretical background. Laboratory directors and managers responsible for hiring scientists must take numerous factors into consideration when selecting candidates. Clinics with low cycle volumes will require embryologists with broader skill sets as they are likely to be responsible for all aspects of the laboratory, whereas clinics performing thousands of cycles per year may employ receptionists and technicians to manage the administrative laboratory duties so that scientists can focus on the embryology work.

Concurrently, IVF has become more complex due to the adoption of highly technological laboratory procedures, including cryopreservation of eggs and embryos, micromanipulation and pre-implantation genetic screening. In addition, the patient population being treated has broadened and often includes not only the intended parents but also gamete donors or gestational surrogates. It is critical therefore for IVF laboratories to implement and maintain the highest standards of quality. Quality can be an elusive concept and is often in the eye of the beholder. In an IVF laboratory it is frequently defined by a clinic’s success rates or the results of inspections by regulatory agencies such as the College of American Pathologists (CAP) or a laboratory’s ability to offer the latest technology. While these attributes are very important and a vital part of a high-quality laboratory, quality comprises many other elements that are often overlooked. This chapter has been written to guide laboratory directors and embryologists in this endeavour.

Selection of the best embryo to transfer, that is, the one that will have the highest potential to result in a live birth, is one of the most important decisions in an in vitro fertilization (IVF) laboratory. A zygote forms with the amalgamation of the female and male gametes, and much information about the viability of an embryo can be gained within 16 to 20 hours after insemination. Interaction of the oocyte and sperm should first be examined with an accurate assessment of fertilization.

Oocyte pick-up is the process whereby oocytes are microscopically identified and pipetted from follicular fluid aspirates and placed into a culture environment prior to in vitro fertilization (IVF). This chapter sets out the laboratory operating procedure for oocyte pick-up and considers practical training methods and competency assessment. From the outset, it is important for embryologists or technicians to be aware that changes in the wider environment of a gamete or embryo can affect its immediate culture environment. The external environment includes not only the space in which the pick-up is performed – the flow hood, which much provide stable temperature and pH maintenance for the oocytes – but also the consumables and culture media used. Task-based training leading to competency should follow a robust pathway. Oocyte pick-up is a critical process and, as such, should be performed effectively and reproducibly by the embryologists within the team.

Appropriate procedures must be documented that describe all the steps performed during an insemination of oocytes for in vitro fertilization (IVF). These procedures must be designed bothe to optimize the fertilization of oocytes and to prevent circumstances that increase the risk of introduction, transmission or spread of communicable diseases through the collection, preparation, culture and/or transfer of patients’ gametes and embryos.

The performance of the embryology laboratory is of imperative importance for the successful outcome of an assisted reproductive technology (ART) cycle. The development and viability of gametes and embryos can be compromised by small fluctuations in their environment, so it is crucial to establish optimal culture conditions at which gametes and embryos are attained and maintained. Having a robust control of culture conditions means that it is not necessary to search for a needle in a haystack when trouble-shooting. In order to ensure and maintain these very specific conditions, quality control (QC) routines need to be established with quality specifications for each quality parameter. These parameters are assessed on a daily, weekly, monthly or annual basis to determine whether they meet certain specifications, followed by any necessary fine-tuning to bring the levels back within the acceptable limits of uncertainty of measurement.

Spermatozoa have to be separated from seminal fluid to omit negative influences and to ensure best medically assisted reproduction (MAR) results. Several preparation techniques exist that can be used to enrich the best motile and morphologically normal spermatozoa: simple washing, swim-up (with or without washing step) and density gradient centrifugation. Every technique has its advantages and disadvantages, and also, the final attribution of the sample (e.g., usage for intrauterine insemination, in vitro fertilization or intracytoplasmic sperm injection) has to be taken into account. Simple washing is optimal for high sperm numbers in normozoospermic patients. Swim-up gives excellent results in normozoospermic and moderate oligoasthenoteratzoospermic (OAT) samples, and density gradient centrifugation is preferred if a sample is moderate to severe OAT. Epididymal aspirated samples can be prepared either by swim-up or by density gradient. Testicular sperm extraction samples have to be processed differently, as steps dissociating the tissue have to be executed first. Good-quality sperm preparation is a prerequisite for the highest success rates in MAR.