Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page i The Boston IVF Handbook of Infertility Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page ii Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page iii The Boston IVF Handbook of Infertility A practical guide for practitioners who care for infertile couples Second Edition Edited by Steven R Bayer MD Michael M Alper MD Alan S Penzias MD Harvard Medical School Boston,MA USA Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page iv © 2007 Informa UK Ltd First published in the United Kingdom in 2007 by Informa Healthcare,4 Park Square,Milton Park,Abingdon,Oxon OX14 4RN.Informa Healthcare is a trading division of Informa UK Ltd.Registered Office:37/41 Mortimer Street, London W1T 3JH.Registered in England and Wales Number 1072954. Tel.:+44 (0)20 7017 6000 Fax.:+44 (0)20 7017 6699 E-mail:[email protected] Website:www.informahealthcare.com All rights reserved.No part of this publication may be reproduced,stored in a retrieval system,or transmitted,in any form or by any means,electronic,mechanical,photocopying,recording,or otherwise,without the prior permission of the publisher or in accordance with the provisions of the Copyright,Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Althougheveryefforthasbeenmadetoensurethatallownersofcopyrightmaterialhavebeenacknowledgedinthis publication,wewouldbegladtoacknowledgeinsubsequentreprintsoreditionsanyomissionsbroughttoourattention. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication,the ultimate responsibility rests with the prescribing physician.Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein.For detailed prescribing information or instructions on the use of any product or procedure discussed herein,please consult the prescribing information or instructional material issued by the manufacturer. A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Data available on application ISBN 10 0 415 39432 5 ISBN 13 978 0 415 39432 1 Distributed in North and South America by Taylor & Francis 6000 Broken Sound Parkway,NW (Suite 300) Boca Raton,FL 33487,USA Within Continental USA Tel:1(800)272 7737;Fax:1(800)374 3401 Outside Continental USA Tel:(561)994 0555;Fax:(561)361 6018 E-mail:[email protected] Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover,Hampshire SP10 5BE,UK Tel.:+44 (0)1264 332424 E-mail:[email protected] Composition by C&M Digitals (P) Ltd,Chennai,India Printed and bound by Replika Press Pvt Ltd Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page v Contents List of Contributors vii Preface ix Acknowledgments x About Boston IVF xi Disclaimer xii 1. Overview of infertility 1 Alan S Penzias 2. Factors affecting fertility 15 Steven R Bayer 3. The infertility workup 25 Steven R Bayer and Michael M Alper 4. Getting the patient ready for a pregnancy 45 Steven R Bayer 5. Clinical algorithms 67 Michael M Alper 6. Treatment options I:ovulation induction 75 Selwyn P Oskowitz 7. Treatment options II:intrauterine insemination 85 Steven R Bayer 8. Treatment options III:in vitro fertilization 91 Michael M Alper 9. Preimplantation genetic screening and diagnosis 111 Alison E Zimon and Kim L Thornton 10. Third party reproduction:egg donation and gestational surrogacy 121 Brian M Berger 11. Modern management of ectopic pregnancy 135 David A Ryley v Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page vi HANDBOOK OF INFERTILITY 12. Integrating quality management into a fertility practice 149 Michael M Alper 13. The true ART:how to deliver the best patient care 157 Merle J Berger 14. Medical ethics in reproductive medicine 165 Steven R Bayer and Kim L Thornton 15. The informed consent process 175 Steven R Bayer 16. The mind/body connection 177 Alice D Domar 17. Infertility counseling:the role of the social worker 187 Jeanie Ungerleider,Terry Chen Rothchild,and Lynn Nichols 18. Insurance and coding issues 195 Steven R Bayer and Karen Parlee 19. Educational resources 205 Steven R Bayer 20. Forms and documents 207 Steven R Bayer 21. Quick reference 241 Index 249 vi Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page vii Contributors Michael M Alper MD Karen Parlee Boston IVF Boston IVF Harvard Medical School Waltham,MA Boston,MA USA USA Alan S Penzias MD Steve R Bayer MD Boston IVF Boston IVF Harvard Medical School Harvard Medical School Boston,MA Boston,MA USA USA Brian M Berger MD Terry Chen Rothchild LICSW BCD Boston IVF Boston IVF Boston,MA Harvard Medical School USA Boston,MA USA David A Ryley MD Merle J Berger MD Boston IVF Boston IVF Harvard Medical School Harvard Medical School Boston,MA Boston,MA USA USA Kim L Thornton MD Alice D Domar PhD Boston IVF Boston IVF Harvard Medical School Harvard Medical School Boston,MA Boston,MA USA USA Lynn Nichols LICSW BCD Jeanie Ungerleider LICSW BCD Boston IVF Boston IVF Boston,MA Boston,MA USA USA Selwyn P Oskowitz MD Alison E Zimon MD Boston IVF Boston IVF Harvard Medical School Harvard Medical School Boston,MA Boston,MA USA USA vii Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page viii Prelims-Boston-IVF-8019.qxd 12/21/2006 8:52 PM Page ix Preface Boston IVF (BIVF) has been one of our country’s premier reproductive medicine centers for nearly 25 years.With a long list of “firsts” in New England and in the United States, it has provided leadership in both clinical care and academic medicine.Ten years ago,I joined the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center (BIDMC),Harvard Medical School,as the Director of the Division of Reproductive Endocrinology and Infertility. Dr. Benjamin Sachs, Chairman of the Department, forged new ground and merged Boston IVF with the Academic Department and, as a result, Boston IVF became the Clinical Arm of the REI Division. During my 10 years with Boston IVF and BIDMC, this group became the largest US IVF center developing cutting edge protocols for clinical care and making quality assurance and quality improvement top priorities. At the same time, it opened its doors to education and research, rounding out its mission in reproductive medicine. Becoming the first US IVF program to obtain ISO 9000-2000 certification and being awarded the largest infertility trial at a single center by the National Institute of Health (called the FASTT Trial) are just 2 examples of this mission of excellence.Throughout these past years BIVF clinicians have continually presented data from their extensive database at national meetings and in our medical journals,a process through which they have been able to provide the answers to numerous key questions about infertility care. Now with the second edition of The Boston IVF Handbook of Infertility,Boston IVF clinicians are sharing their expertise,their vast experience, their protocols,clinical algorithms,and the forms they use on a day-to-day basis with other providers of infertility care.From A to Z,this handbook will undoubt- edly help you provide your patients with those aspects of contemporary care available in your office as well as an understanding of the processes they will encounter when they are referred on for higher tech care. It was an honor and privilege for me to work with the clinicians and staff at Boston IVF for nearly a decade.As you read and refer to this handbook,you will soon see why! Richard H.Reindollar MD Chair Department of Obstetrics and Gynecology Dartmouth Medical School Dartmouth Hitchcock Medical Center Hanover,NH USA ix