Assisted Reproduction Techniques
Challenges and Management Options
2. Auflage Juli 2021
816 Seiten, Hardcover
Wiley & Sons Ltd
ISBN:
978-1-119-62210-9
John Wiley & Sons
Weitere Versionen
Assisted reproduction techniques have led to the birth of 8 million babies worldwide
Assisted reproduction techniques (ART), in particular in-vitro fertilization and intra-cytoplasmic sperm injection, are the most advanced forms of infertility treatment. They involve numerous counseling, medical, surgical and laboratory-based steps. At each step various problems and complications could be encountered that challenge even the most experienced ART practitioners. Moreover, patients with complex medical disorders may require ART, presenting further challenges.
Assisted Reproduction Techniques will stimulate resourceful thinking in the ART practitioner when faced with these challenges. It outlines various management options, the reasoning behind them, and the evidence on which they are based to enable the practitioner to choose the most suitable solution for the needs of each patient.
Written by 171 internationally renowned experts, Assisted Reproduction Techniques follows the patient's journey throughout the whole ART process, with chapters on:
* Counseling and preparation
* Pituitary suppression and ovarian stimulation
* Oocyte retrieval
* Embryo transfer
* The luteal phase
* The ART laboratory
* The male patient
* The ART pregnancy
* General and organizational issues
Each of the 116 concise chapters includes clinical cases, background, evidence-based practical management options, preventive measures, key-point summaries of the important details and answers to questions patients ask.
Assisted Reproduction Techniques first edition has established its place as a "must read" for ART trainees and practitioners alike, and in this second edition all chapters have been updated, with the addition of new ones addressing training issues, organizational and business skills, and social media use in ART.
Contributors xiii
Preface to the second edition xxviii
Preface to the first edition xxix
How to use this book xxx
Abbreviations xxxi
Section 1: Counseling and preparation 1
1 Risk of cancer from ovarian stimulation 3
Yadava Jeve
2 Risk of early menopause following IVF treatment 9
Sesh Kamal Sunkara
3 The HIV-positive female 12
Mark V. Sauer and Shelley Dolitsky
4 The HIV-positive male 19
Mark V. Sauer and Shelley Dolitsky
5 The hepatitis B or C carrier patient 26
Justin Chu
6 The patient with cystic fibrosis 32
Tarek El-Toukhy
7 The patient on medication 37
Pedro Melo and Arri Coomarasamy
8 The patient with thrombophilia 48
Yorain Sri Ranjan and Ying C. Cheong
9 The patient with autoimmune disorders 56
Giulia Mariani and José Bellver
10 The patient with malignant disease: fertility preservation 61
Arri Coomarasamy and Manal Elgendy
11 The patient with heart disease 69
Anna S. Herrey and Catherine Nelson-Piercy
12 The patient with diabetes 75
Mohammed A. Khan, Neelam Potdar, and Justin C. Konje
13 The patient with thyroid disease 81
Shiao-yng Chan
14 The patient with hyperprolactinemia 89
John Ayuk
15 The patient with polycystic ovaries 96
Adam H. Balen
16 The renal transplant patient 103
Justin Chu and Lynne Robinson
17 The patient with previous pelvic irradiation 110
Vishvanath C. Karande
18 Female fertility after chemotherapy 116
Nivedita Reddy
19 The patient with abnormal cervical cytology 123
Martyn Underwood and William Rhys Parry-Smith
20 The patient with previous borderline ovarian tumor 127
Arri Coomarasamy, Kavita Singh, and Jennifer Tamblyn
21 The patient with an endometrioma 132
Spyros Chouliaras and Luciano G. Nardo
22 The patient with cervical stenosis 137
Khaldoun Sharif
23 Vaccination and ART 142
Arri Coomarasamy and Rima Dhillon-Smith
24 The patient with hydrosalpinx 147
Annika Strandell
25 The patient with hydrosalpinx and contraindication to laparoscopy 153
Basim Abu-Rafea
26 The patient with reduced ovarian reserve 159
Scott M. Nelson
27 The patient with congenital uterine anomalies 166
Rima Dhillon-Smith and Pallavi Latthe
28 The patient with congenital cervico-vaginal anomalies 171
Rima Dhillon-Smith and Pallavi Latthe
29 The patient with uterine fibroids 176
Kugajeevan Vigneswaran and Haitham Hamoda
30 The patient with adenomyosis 182
Andreas Athanasakis and Arri Coomarasamy
31 The patient with previous Essure(r) sterilization 187
T. Justin Clark
32 The patient with previous endometrial ablation 192
T. Justin Clark
33 The couple with recurrent implantation failure 200
Lukasz Polanski and Yakoub Khalaf
34 The patient with previous uterine artery embolization 207
Kugajeevan Vigneswaran and Haitham Hamoda
35 The patient with endometrial polyp 212
Arri Coomarasamy and Laurentiu Craciunas
36 The obese female patient 217
Mostafa Metwally and Bolarinde Ola
37 The patient with Asherman syndrome 223
Alessandro Conforti, Giuseppe Iorio, and Carlo Alviggi
38 The older patient 228
Giselle Crawford and William Ledger
39 Requests for mild or natural cycle IVF treatment 234
Brad B. Swelstad and Suheil J. Muasher
40 The patient with psychosexual problems 239
Penny Goold and Elizabeth Howland
41 The patient needing third-party reproduction 246
Imad Aboujaoude and Teddy Tadros
42 Social oocyte freezing 252
Valerie L. Peddie and Smriti Ray Chaudhuri Bhatta
43 The male and female patients following bariatric surgery 258
Zaher Merhi and Ali Ahmed Bazzi
44 Endometrial receptivity testing 265
Laurentiu Craciunas and Arri Coomarasamy
Section 2: Pituitary suppression and ovarian stimulation phase 271
45 Poor response during ovarian stimulation 273
Pedro Melo, Lynne Robinson, and Arri Coomarasamy
46 Ovarian stimulation for IVF in a patient at high risk of ovarian hyperstimulation syndrome 279
Khaldoun Sharif and Ahmed G. Serour
47 Unable to achieve pituitary down-regulation 284
K. Jayaprakasan and Nicholas Raine-Fenning
48 The patient discovered pregnant during pituitary down-regulation 291
Mohammed Khairy Mahmoud and Arri Coomarasamy
49 Ovarian cysts following pituitary down-regulation 296
Alison Taylor
50 Missed IVF medications 302
Pedro Melo, Lynne Robinson, and Arri Coomarasamy
51 The ART patient with a history of estrogen-receptor
positive cancer 309
Murat Sönmezer and Volkan Turan
52 The patient over-responding to controlled ovarian stimulation during IVF 315
Khaldoun Sharif
Section 3: Oocyte retrieval 323
53 General anesthesia or sedation for oocyte retrieval? 325
Claire Scanlon and David Green
54 Delayed oocyte retrieval 331
Khaldoun Sharif
55 Empty follicle syndrome 337
Aboubakr Mohamed Elnashar
56 Bleeding following oocyte retrieval 344
Annika K. Ludwig and Barbara Sonntag
57 To flush or not to flush follicles at oocyte retrieval 351
Anne E. Martini and Micah J. Hill
58 Inaccessible ovaries at oocyte retrieval 358
Aboubakr Mohamed Elnashar
59 Endometriotic cysts at oocyte retrieval 363
Graciela Kohls Ilgner and Juan Antonio García-Velasco
60 Inadvertent injury during oocyte retrieval 369
Khaldoun Sharif
61 Dealing with equipment failure during oocyte retrieval 377
Isla Robertson and Ying C. Cheong
Section 4: Embryo transfer 381
62 How many embryos to transfer? 383
Ellen Armstrong and Arri Coomarasamy
63 Poor endometrial development in ART 390
Jyotsna Pundir and Arri Coomarasamy
64 Endometrial cavity fluid identified during IVF treatment 400
Arri Coomarasamy and Yealin Chung
65 Difficult embryo transfer 404
Khaldoun Sharif
66 Excess cervical mucus and retained embryos at embryo transfer 413
Hassan N. Sallam, Ahmed F. Galal, and Fady S. Moeity
67 Life after embryo transfer 419
Kelton Tremellen
Section 5: The luteal phase 427
68 Vaginal bleeding in the luteal phase after IVF 429
Carol Coughlan and Bolarinde Ola
69 Pelvic infection after IVF 435
Muhammad Faisal Aslam and Ali Ahmad Bazzi
70 The patient presenting with ovarian hyperstimulation syndrome 440
Khaldoun Sharif and Dania Al-Ramahi
71 Adnexal torsion after IVF 447
Jenna Turocy and Beth W. Rackow
72 Exposure to infection in the luteal phase of IVF 453
Pedro Melo and Arri Coomarasamy
Section 6: The ART laboratory 465
73 Total failure of fertilization after conventional IVF - rescue ICSI 467
A. Albert Yuzpe
74 Couples not wishing to create surplus embryos in IVF 473
Hossam Mohamed
75 Routine preimplantation genetic testing for aneuploidy 478
Lukasz Polanski and Yakoub Khalaf
76 Choosing an embryo for transfer 484
Peter Kovacs and Szabolcs Matyas
77 Globozoospermia 492
Odai A. M. Alqawasmeh and Christopher L. R. Barratt
78 Total failure of fertilization after ICSI 498
Kaoru Yanagida
79 Refreezing of embryos 503
Jerome H. Check and Donna Summers
80 Infection in embryo culture medium 509
Alison Campbell and Louise Best
81 ICSI or IVF for nonmale-factor infertility? 515
Samuel Dobson and Bolarinde Ola
82 Cryostorage failure in ART 522
Christopher P. Moutos, Angela H. Liu, and John Y. Phelps
83 The ART program during a disaster 527
Richard P. Dickey and Carla Ball White
84 Using the wrong sperm or embryos in IVF 533
Khaldoun Sharif and Majd M. Ezal-Deen
Section 7: The male patient 539
85 Unexpected inability to produce a semen sample on the day of oocyte retrieval 541
Khaldoun Sharif, Majd M. Ezal-Deen, and Gyath Karadsheh
86 The azoospermic patient 545
Khaldoun Sharif and Ali Al-Rawahneh
87 ART in men with Klinefelter syndrome 553
Medhat Amer and Emad Fakhry
88 ART in men with 100% immotile sperm 559
Jose Vázquez Núñez, Juan José Artazkoz Marques de Oliveira, Patricia Hernández Delgado, Ayrton Artazkoz Marques de Oliveira, and Neuda Marques de Oliveira
89 Request for posthumous fatherhood with perimortem surgical sperm retrieval 565
Mahmoud Mima, Samuel J. Ohlander, Rodrigo L. Pagani, Heather E. Ross, and Lawrence S. Ross
90 Retrograde ejaculation and anejaculation 575
Hussain M. Alnajjar and Asif Muneer
91 Sperm retrieval in cancerous testes 580
Wael Almajed, Saad Aldousari, and Armand Zini
92 Leukocytospermia and ART 584
Giuseppe Ricci
93 The infertile male patient with a genetic cause 589
Marlon P. Martinez and Ashok Agarwal
94 Y chromosome microdeletions and ART 598
Sherman J. Silber and Sierra Goldsmith
95 DNA fragmentation, antioxidants and ART 606
Sarah J. Martins da Silva
Section 8: The ART pregnancy 613
96 Unexpected number or sex of babies after IVF 615
Majd M. Ezal-Deen, Mohamad Bani-Domi, and Omar Sharif
97 Suspected ectopic pregnancy after IVF 620
Vishvanath C. Karande, Liselotte Mettler,, and Ibrahim Alkatout
98 Cervical ectopic pregnancy after IVF 626
Usha Verma and Sabrina Pastor-Carvajal
99 Heterotopic pregnancy after IVF 632
Abdel-Maguid Ramzy
100 Multifetal pregnancy reduction after IVF 638
Omar Taso and Maher Maaita
101 Multiple pregnancy after IVF: how to reduce preterm delivery 644
Shawqi Saleh and Maysa Khadra
102 Hyperreactio luteinalis after IVF 650
Muataz Al-Ramahi and Omar Sharif
103 Lactation by a commissioning mother in surrogacy 654
Pavithra Rao and Frank P. Biervliet
104 Children of ART 658
Defne Saatci and Alastair G. Sutcliffe
Section 9: General and organizational issues 665
105 Managing physical symptoms during IVF 667
Chiara Achilli and Jyotsna Pundir
106 IVF when the prognosis is very poor or futile 673
Khaldoun Sharif
107 Dealing with the emotional distress following failed IVF 678
Sarah R. Holley, Lauri A. Pasch, and Alice D. Domar
108 Couple splitting while embryos are in storage 684
Masoud Afnan
109 Unexpected drop in the IVF clinic pregnancy rate 690
Bulent Urman and Kayhan Yakin
110 Natural fertility after IVF 696
Frank Nawroth and Annika K. Ludwig
111 Training in ART 699
Ryan J. Heitmann
112 Keeping up to date in ART practice 706
Bassel H. Al-Wattar and Khalid S. Khan
113 Cross-border reproductive care 714
Mahmoud Salama, Lynn M. Westphal, Marcia C. Inhorn, and Pasquale Patrizio
114 Satellite and transport ART treatment 720
M. F. González Echeverría and J. A. Blaquier
115 Social media use in ART 725
Natalie M. Crawford, Roohi Jeelani, Lora K. Shahine, and Kenan Omurtag
116 Managing an ART unit as a profitable business 733
Michael H. Fakih, Ahmad Fakih, and Amanda Fakih
Index 739
Preface to the second edition xxviii
Preface to the first edition xxix
How to use this book xxx
Abbreviations xxxi
Section 1: Counseling and preparation 1
1 Risk of cancer from ovarian stimulation 3
Yadava Jeve
2 Risk of early menopause following IVF treatment 9
Sesh Kamal Sunkara
3 The HIV-positive female 12
Mark V. Sauer and Shelley Dolitsky
4 The HIV-positive male 19
Mark V. Sauer and Shelley Dolitsky
5 The hepatitis B or C carrier patient 26
Justin Chu
6 The patient with cystic fibrosis 32
Tarek El-Toukhy
7 The patient on medication 37
Pedro Melo and Arri Coomarasamy
8 The patient with thrombophilia 48
Yorain Sri Ranjan and Ying C. Cheong
9 The patient with autoimmune disorders 56
Giulia Mariani and José Bellver
10 The patient with malignant disease: fertility preservation 61
Arri Coomarasamy and Manal Elgendy
11 The patient with heart disease 69
Anna S. Herrey and Catherine Nelson-Piercy
12 The patient with diabetes 75
Mohammed A. Khan, Neelam Potdar, and Justin C. Konje
13 The patient with thyroid disease 81
Shiao-yng Chan
14 The patient with hyperprolactinemia 89
John Ayuk
15 The patient with polycystic ovaries 96
Adam H. Balen
16 The renal transplant patient 103
Justin Chu and Lynne Robinson
17 The patient with previous pelvic irradiation 110
Vishvanath C. Karande
18 Female fertility after chemotherapy 116
Nivedita Reddy
19 The patient with abnormal cervical cytology 123
Martyn Underwood and William Rhys Parry-Smith
20 The patient with previous borderline ovarian tumor 127
Arri Coomarasamy, Kavita Singh, and Jennifer Tamblyn
21 The patient with an endometrioma 132
Spyros Chouliaras and Luciano G. Nardo
22 The patient with cervical stenosis 137
Khaldoun Sharif
23 Vaccination and ART 142
Arri Coomarasamy and Rima Dhillon-Smith
24 The patient with hydrosalpinx 147
Annika Strandell
25 The patient with hydrosalpinx and contraindication to laparoscopy 153
Basim Abu-Rafea
26 The patient with reduced ovarian reserve 159
Scott M. Nelson
27 The patient with congenital uterine anomalies 166
Rima Dhillon-Smith and Pallavi Latthe
28 The patient with congenital cervico-vaginal anomalies 171
Rima Dhillon-Smith and Pallavi Latthe
29 The patient with uterine fibroids 176
Kugajeevan Vigneswaran and Haitham Hamoda
30 The patient with adenomyosis 182
Andreas Athanasakis and Arri Coomarasamy
31 The patient with previous Essure(r) sterilization 187
T. Justin Clark
32 The patient with previous endometrial ablation 192
T. Justin Clark
33 The couple with recurrent implantation failure 200
Lukasz Polanski and Yakoub Khalaf
34 The patient with previous uterine artery embolization 207
Kugajeevan Vigneswaran and Haitham Hamoda
35 The patient with endometrial polyp 212
Arri Coomarasamy and Laurentiu Craciunas
36 The obese female patient 217
Mostafa Metwally and Bolarinde Ola
37 The patient with Asherman syndrome 223
Alessandro Conforti, Giuseppe Iorio, and Carlo Alviggi
38 The older patient 228
Giselle Crawford and William Ledger
39 Requests for mild or natural cycle IVF treatment 234
Brad B. Swelstad and Suheil J. Muasher
40 The patient with psychosexual problems 239
Penny Goold and Elizabeth Howland
41 The patient needing third-party reproduction 246
Imad Aboujaoude and Teddy Tadros
42 Social oocyte freezing 252
Valerie L. Peddie and Smriti Ray Chaudhuri Bhatta
43 The male and female patients following bariatric surgery 258
Zaher Merhi and Ali Ahmed Bazzi
44 Endometrial receptivity testing 265
Laurentiu Craciunas and Arri Coomarasamy
Section 2: Pituitary suppression and ovarian stimulation phase 271
45 Poor response during ovarian stimulation 273
Pedro Melo, Lynne Robinson, and Arri Coomarasamy
46 Ovarian stimulation for IVF in a patient at high risk of ovarian hyperstimulation syndrome 279
Khaldoun Sharif and Ahmed G. Serour
47 Unable to achieve pituitary down-regulation 284
K. Jayaprakasan and Nicholas Raine-Fenning
48 The patient discovered pregnant during pituitary down-regulation 291
Mohammed Khairy Mahmoud and Arri Coomarasamy
49 Ovarian cysts following pituitary down-regulation 296
Alison Taylor
50 Missed IVF medications 302
Pedro Melo, Lynne Robinson, and Arri Coomarasamy
51 The ART patient with a history of estrogen-receptor
positive cancer 309
Murat Sönmezer and Volkan Turan
52 The patient over-responding to controlled ovarian stimulation during IVF 315
Khaldoun Sharif
Section 3: Oocyte retrieval 323
53 General anesthesia or sedation for oocyte retrieval? 325
Claire Scanlon and David Green
54 Delayed oocyte retrieval 331
Khaldoun Sharif
55 Empty follicle syndrome 337
Aboubakr Mohamed Elnashar
56 Bleeding following oocyte retrieval 344
Annika K. Ludwig and Barbara Sonntag
57 To flush or not to flush follicles at oocyte retrieval 351
Anne E. Martini and Micah J. Hill
58 Inaccessible ovaries at oocyte retrieval 358
Aboubakr Mohamed Elnashar
59 Endometriotic cysts at oocyte retrieval 363
Graciela Kohls Ilgner and Juan Antonio García-Velasco
60 Inadvertent injury during oocyte retrieval 369
Khaldoun Sharif
61 Dealing with equipment failure during oocyte retrieval 377
Isla Robertson and Ying C. Cheong
Section 4: Embryo transfer 381
62 How many embryos to transfer? 383
Ellen Armstrong and Arri Coomarasamy
63 Poor endometrial development in ART 390
Jyotsna Pundir and Arri Coomarasamy
64 Endometrial cavity fluid identified during IVF treatment 400
Arri Coomarasamy and Yealin Chung
65 Difficult embryo transfer 404
Khaldoun Sharif
66 Excess cervical mucus and retained embryos at embryo transfer 413
Hassan N. Sallam, Ahmed F. Galal, and Fady S. Moeity
67 Life after embryo transfer 419
Kelton Tremellen
Section 5: The luteal phase 427
68 Vaginal bleeding in the luteal phase after IVF 429
Carol Coughlan and Bolarinde Ola
69 Pelvic infection after IVF 435
Muhammad Faisal Aslam and Ali Ahmad Bazzi
70 The patient presenting with ovarian hyperstimulation syndrome 440
Khaldoun Sharif and Dania Al-Ramahi
71 Adnexal torsion after IVF 447
Jenna Turocy and Beth W. Rackow
72 Exposure to infection in the luteal phase of IVF 453
Pedro Melo and Arri Coomarasamy
Section 6: The ART laboratory 465
73 Total failure of fertilization after conventional IVF - rescue ICSI 467
A. Albert Yuzpe
74 Couples not wishing to create surplus embryos in IVF 473
Hossam Mohamed
75 Routine preimplantation genetic testing for aneuploidy 478
Lukasz Polanski and Yakoub Khalaf
76 Choosing an embryo for transfer 484
Peter Kovacs and Szabolcs Matyas
77 Globozoospermia 492
Odai A. M. Alqawasmeh and Christopher L. R. Barratt
78 Total failure of fertilization after ICSI 498
Kaoru Yanagida
79 Refreezing of embryos 503
Jerome H. Check and Donna Summers
80 Infection in embryo culture medium 509
Alison Campbell and Louise Best
81 ICSI or IVF for nonmale-factor infertility? 515
Samuel Dobson and Bolarinde Ola
82 Cryostorage failure in ART 522
Christopher P. Moutos, Angela H. Liu, and John Y. Phelps
83 The ART program during a disaster 527
Richard P. Dickey and Carla Ball White
84 Using the wrong sperm or embryos in IVF 533
Khaldoun Sharif and Majd M. Ezal-Deen
Section 7: The male patient 539
85 Unexpected inability to produce a semen sample on the day of oocyte retrieval 541
Khaldoun Sharif, Majd M. Ezal-Deen, and Gyath Karadsheh
86 The azoospermic patient 545
Khaldoun Sharif and Ali Al-Rawahneh
87 ART in men with Klinefelter syndrome 553
Medhat Amer and Emad Fakhry
88 ART in men with 100% immotile sperm 559
Jose Vázquez Núñez, Juan José Artazkoz Marques de Oliveira, Patricia Hernández Delgado, Ayrton Artazkoz Marques de Oliveira, and Neuda Marques de Oliveira
89 Request for posthumous fatherhood with perimortem surgical sperm retrieval 565
Mahmoud Mima, Samuel J. Ohlander, Rodrigo L. Pagani, Heather E. Ross, and Lawrence S. Ross
90 Retrograde ejaculation and anejaculation 575
Hussain M. Alnajjar and Asif Muneer
91 Sperm retrieval in cancerous testes 580
Wael Almajed, Saad Aldousari, and Armand Zini
92 Leukocytospermia and ART 584
Giuseppe Ricci
93 The infertile male patient with a genetic cause 589
Marlon P. Martinez and Ashok Agarwal
94 Y chromosome microdeletions and ART 598
Sherman J. Silber and Sierra Goldsmith
95 DNA fragmentation, antioxidants and ART 606
Sarah J. Martins da Silva
Section 8: The ART pregnancy 613
96 Unexpected number or sex of babies after IVF 615
Majd M. Ezal-Deen, Mohamad Bani-Domi, and Omar Sharif
97 Suspected ectopic pregnancy after IVF 620
Vishvanath C. Karande, Liselotte Mettler,, and Ibrahim Alkatout
98 Cervical ectopic pregnancy after IVF 626
Usha Verma and Sabrina Pastor-Carvajal
99 Heterotopic pregnancy after IVF 632
Abdel-Maguid Ramzy
100 Multifetal pregnancy reduction after IVF 638
Omar Taso and Maher Maaita
101 Multiple pregnancy after IVF: how to reduce preterm delivery 644
Shawqi Saleh and Maysa Khadra
102 Hyperreactio luteinalis after IVF 650
Muataz Al-Ramahi and Omar Sharif
103 Lactation by a commissioning mother in surrogacy 654
Pavithra Rao and Frank P. Biervliet
104 Children of ART 658
Defne Saatci and Alastair G. Sutcliffe
Section 9: General and organizational issues 665
105 Managing physical symptoms during IVF 667
Chiara Achilli and Jyotsna Pundir
106 IVF when the prognosis is very poor or futile 673
Khaldoun Sharif
107 Dealing with the emotional distress following failed IVF 678
Sarah R. Holley, Lauri A. Pasch, and Alice D. Domar
108 Couple splitting while embryos are in storage 684
Masoud Afnan
109 Unexpected drop in the IVF clinic pregnancy rate 690
Bulent Urman and Kayhan Yakin
110 Natural fertility after IVF 696
Frank Nawroth and Annika K. Ludwig
111 Training in ART 699
Ryan J. Heitmann
112 Keeping up to date in ART practice 706
Bassel H. Al-Wattar and Khalid S. Khan
113 Cross-border reproductive care 714
Mahmoud Salama, Lynn M. Westphal, Marcia C. Inhorn, and Pasquale Patrizio
114 Satellite and transport ART treatment 720
M. F. González Echeverría and J. A. Blaquier
115 Social media use in ART 725
Natalie M. Crawford, Roohi Jeelani, Lora K. Shahine, and Kenan Omurtag
116 Managing an ART unit as a profitable business 733
Michael H. Fakih, Ahmad Fakih, and Amanda Fakih
Index 739
