Roger Hart

By Rashi Kalra and Roger J Hart

This chapter presents a contemporary summary of the evidence of the clinical impact of submucosal fibroids and discusses the methods used to investigate and surgically manage this common gynaecological condition.

Part of the book: Fertility-oriented Female Reproductive Surgery

By Fiona Langdon, Jennifer Pontre and Roger J. Hart

Polycystic ovarian syndrome is the commonest cause of anovulatory infertility. This chapter will explore fertility treatment options for this condition including the risks, benefits and success rates for different treatment methods. The importance of close patient monitoring with hormone levels and pelvic ultrasounds to ensure mono-ovulation and to avoid ovarian hyperstimulation syndrome will be highlighted.

Part of the book: Testes and Ovaries

By Fiona Langdon and Roger Hart

Pregnancies resulting from fertility treatment are associated with higher rates of multiple pregnancy and have higher rates of pregnancy complications than spontaneously conceived pregnancies. Methods exist to make fertility treatment safer and less likely to result in multiple pregnancy and practitioners should be practicing fertility treatment with the aim to produce a healthy, term, singleton pregnancy. Approaches to minimising the risk of multiple pregnancy include carefully monitoring ovulation induction (OI) cycles to produce mono-follicular ovulation. Identifying patients at risk of excessive response to ovulation induction and treating them with low dose therapies and close monitoring is a critical step in practicing safe OI treatment. Performing single embryo transfer in all but exceptional cases of in-vitro fertilisation (IVF), and never transferring more than two embryos, is the single, most successful way to reduce the multiple pregnancy rate with IVF. An appreciation of the increased risk of mono-chorionic twinning with IVF is also important. This chapter will explore ways to minimise the risk of multiple pregnancy with a variety of fertility treatments.

Part of the book: Multiple Pregnancy

By Tamara Hunter and Roger Hart

With increasing global obesity, there is a growing body of research looking at the impact of this on reproduction. Both male and female fertility are impacted on by being overweight or obese. Although the pathophysiology is not clear, it appears that obesity impacts endocrine function in men and women, oocyte and sperm quality, embryo quality, endocrine receptivity, and implantation. Miscarriage, pregnancy, and live birth rates and the risk of congenital malformations are all influenced by obesity. Transgenerational health is also affected, with metabolic, endocrine, and reproductive outcomes in the offspring being negatively affected by both paternal and maternal obesity. It appears that weight loss results in improvements in these outcomes and various strategies have been employed including lifestyle and behavior modification, pharmacological agents, and also bariatric surgery. This chapter aims to explore the reproductive outcomes of obesity and how this can be best managed to improve outcomes.

Part of the book: Obesity

By Jennifer Pontré and Roger Hart

Increasing concern exists regarding male reproductive health worldwide. This is due to the appearance of medical reports outlining apparent adverse trends, such as a worldwide decline in total fertility rate, and an increase in testicular disorders such as testicular cancer, cryptorchidism—in parallel with a probable decline in semen quality. This is of particular concern as there is evidence to suggest that a poor sperm count is potentially associated with overall lifelong morbidity and mortality, and is effectively a predictor of lifelong health risk. This chapter examines the evidence for this decline and its potential early life causes, from in-utero exposures to childhood development.

Part of the book: Male Reproductive Health