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Robert Harrison - The Smart Guide to Infertility: Myths and Reality

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Robert Harrison The Smart Guide to Infertility: Myths and Reality
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The Smart Guide to Infertility provides an authoritative companion to seeking help from specialists, giving clear but indepth guidance as to the causes of infertility, the pros and cons of currently available treatments, and an approach to deciding what is right for you, unbiased by any commercial interests

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First published as a print book in 2009 by Hammersmith Press Limited

First published in digital form by Hammersmith Health Books, an imprint of Hammersmith Books Limited, 2012

www.hammersmithbooks.co.uk

2009, 2012 Professor Robert Harrison

Updated 2012 for Hammersmith Health Books

All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission of the publishers and copyright holder.

Disclaimer
Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author nor the publisher can accept any legal responsibility or liability for any errors or omissions that may have been made. In particular (but without limiting the generality of the preceding disclaimer) while every effort has been made to ensure that the contents of this book are accurate, it must not be treated as a substitute for qualified medical advice.

British Library Cataloguing in Publication Data: A CIP record of this book is available from the British Library.

ISBN 9781781610114

Commissioning Editor: Georgina Bentliff
Production by Helen Whitehorn, Pathmedia
Designed and typeset by Julie Bennett

PERSONAL DEDICATIONS

Primary dedication

To Caroline 21.7.1945 - 22.1.2008

My strength and better half, taken too soon

Also

To my children Peta, Sinead, Robert and Charlotte,

my grandchildren

And

To all the one-finger typists everywhere

Contents

by Caroline M Harrison

To all the patients and colleagues of all disciplines I have worked for and with over the years. Particular thanks are due to staff in the HARI (Human Assisted Reproduction Ireland) Unit for their support and encouragement and for jogging my memory about techniques when needed. I am also indebted to Dr Cathy Allen, Dr Edgar Mocanu, Mary OConor, Anne Marie and Niall Sudway and Kathy and Marcus Cosgrave for putting me right on different issues at the pre-proof stage. I acknowledge being able to quote data from ESHRE, the CDC and HARI. Finally I salute the friendly guidance of Georgina Bentliff of Hammersmith Press who I have found really great at licking the final product into a more user-friendly shape.

The Author, Robbie Harrison, was brought up in Liverpool, qualifying in Medicine from the Royal College of Surgeons in Ireland (RCSI) Dublin in 1967. He trained in Obstetrics and Gynacology, firstly in Dublin at the Mater and Rotunda Hospitals, moving on in 1972 to Queen Charlottes and Chelsea Hospitals for Women and The Royal Postgraduate Medical School London University as Lecturer and Honorary Senior Registrar. His in-depth involvement in the management of infertility began then and has continued to the present day, some 37 years later.

Following his return to Dublin in 1976, initially as Consultant/Senior Lecturer at Trinity College and the Rotunda and then Associate Professor, he set up the first specific, couple-orientated, clinics in Ireland to provide modern management of infertility at the Rotunda and St Jamess Hospitals. This has included pioneering the various Assisted Reproduction Techniques as they have come on stream clinically, initially at Sir Patrick Dunns (1985) and St Jamess (1986) Hospitals, but from 1989 until his retirement from active practice in 2005, back at the Rotunda. It was here where he founded Human Assisted Reproduction Ireland (The HARI Unit) as well as being the Professor and Head of the RCSI Department of Obstetrics and Gynaecology. The Rotunda/HARI Unit services are ongoing and continue to have a worldwide reputation for research, training and couple care and the Unit is the largest and leading provider of these services in the area of Human Reproduction in the Irish Republic.

During his time in Human Reproduction, as befits someone with a worldwide reputation earned through over 210 published peer review papers and 135 invited presentations, amongst honours gained he chaired the WHO Taskforce on Infertility from 1984 to 1988. He was given the Andres Bello First Class Award by the President of Venezuela in 1992 and he served as President of the International Federation of Fertility Societies 1998-2001. In 2008 he became the Irish Fertility Societys first Honorary Fellow.

The Contributor: Throughout this time until her death in January 2008, Robbies constant companion, muse and mentor was his wife Caroline. Mother to their four children, she was initially a fashion designer, then a social worker and Trinity College Lecturer in Social Studies, becoming latterly the sex and relationship psychotherapist to the Rotunda and HARI unit. She was also a member of the Irish Government Commission on Assisted Human Reproduction (2000-05) and had been steadily gaining recognition as an artist of promise. Now, sadly, written about here posthumously, she is the only other direct contributor to this book. Despite her sudden illness, her qualifications and skills made her the obvious choice to provide the illustrations and the text of the section on physical coital problems and sexual dysfunctions.

This book was written in 2007-8 in the terrible time during the Authors wifes fatal illness with ovarian cancer. It draws foremost upon his experience as a clinician practising daily in the field for over 37 years, but also his knowledge as a teacher, personal researcher and evaluator of the work of others.

He has put together a volume that covers exclusively and comprehensively infertility management as it is today. It is designed principally for those who are wondering if they are infertile. It provides basic facts, personal comments and guidance, but throughout, a greater depth of information is also provided than is perhaps usual in such books as it is this sort of knowledge that, in the Authors experience, the discerning infertile couple of today will demand.

In this guide I aim to provide accurate, up-to-date information on the causes of infertility and on current methods of investigation and treatment . Designed primarily with patients in mind, I hope it may also be useful for healthcare professionals and students occasionally needing in-depth knowledge of the field.

While it should be considered but one of a number of potential sources to be explored, I can confirm that I have written this book in as unbiased a way as possible, drawing on my knowledge and experience in the field, which spans some 37 years. Wherever possible I have included appropriate data from peer-reviewed sources. My personal opinions are summarised and presented clearly as such at the end of each chapter or major chapter-section. I have no commercial affiliations to declare.

The text deliberately introduces the appropriate technical terms that are used by practitioners in the field, together with explanations of each. Simple understandable line drawings and algorithms illustrate salient points. I have described the underlying physiological background (how the body functions) of vital processes, including conception, semen production and the menstrual cycle. It is complex and can be hard to understand; I have tried to simplify it as much as possible but some in-depth knowledge is essential for potentially infertile couples if they are to understand, and cope with, the investigations and treatment that may lie ahead.

My aim is not to replace going for appropriate help with DIY, but to provide couples who are finding it difficult to conceive with a framework of general and specific knowledge regarding possible causes, how these are investigated, what the treatment options are, and the chances of success with each so that they can make educated choices through informed discussion with healthcare professionals. For simplicity, when discussing prognosis (the chances of success) related to a specific treatment, I have assumed both partners are normal in all other respects and that the treatment will be carried out fully, as prescribed. This can, of course, give rise to inaccuracy and over- and under-estimations of potential success as there will often be more than one factor involved in infertility. Additionally, the fecundability (probability of conceiving in a single menstrual cycle) or otherwise of the partner not being treated will always play an important part in eventual success, or lack of it.

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