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This chapter reviews the short period between the exploration of male factor treatment using standard in vitro fertilization in small clinical series initiated in the early 1980s and subsequent development of micromanipulation technologies before ICSI. Instrumental fertilization was developed to improve the incidence of fertilization as well as apply the technology to patients with extreme male factor. A decade later, the Brussels team introduced ICSI, with fertilization rates that were at least twice as high compared to those of earlier micromanipulation approaches. A short history of male factor infertility and the biased views medical specialists showed in favor of solely treating the female partner is discussed in the context of discovery of gametes and the process of fertilization in the nineteenth century. The condition of infertility in men was basically considered untreatable until the 1970s, but as a clinical concept, it was also largely ignored. The possibility of using IVF for effectively treating less fertile men was considered experimental in 1980. The technical and physiological background as well as ambiguous animal models before clinical ICSI are evaluated particularly in the context of why early micromanipulation methods such as partial zona dissection and sub-zonal sperm insertion ultimately failed.
Molar pregnancies are characterized by gross water logging and villous cistern formation. Villous trophoblastic hyperplasia is the microscopic characteristic feature of true molar pregnancies. This chapter reviews the role of ultrasound in early pregnancy in the screening for molar pregnancy. Complete moles are almost always diploid with their chromosomes totally derived from the paternal genome resulting from endoreduplication after monospermic fertilization or more rarely dispermic fertilization of an anucleate oocyte. Usually, the ultrasonographic description of complete hydatidiform moles (CHM) applies to pregnancies between 9 and 12 weeks of amenorrhea. In early pregnancy and in particular in missed miscarriage, independently of the presence of a chromosomal abnormality, the progressive disappearance of the villous vasculature after embryonic death leads to villous hydrops. Overall, the risk of persistent Gestational trophoblastic disorder (pGTD) developing from a histologically confirmed non-molar hydropic miscarriage is considered to be less than 1 in 50,000.
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