Baiju dhea 15.11.12

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DHEA

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Baiju dhea 15.11.12

  1. 1. DHEA in Oocyte Yield and Quality BAIJU P A NCARE IVF CENTRE PARAPPANANGADI, MALAPPURAM Page 1
  2. 2. Dr Ba Ne iju ek o Page 2
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  4. 4. DHEA - Hype or Hope…??? Follicular Dynamics Androgen in Follicular Dynamics What is DHEA? Role of DHEA in Failing Ovaries Side effects of DHEA Literature Search Other Adjuvants Page 4
  5. 5. 8 million 300-400 cycles in reproductive age 1000 follicles recruited/cycle 4,00,000 25,000 4 million 1000 Page 5
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  8. 8. AMH as a predictive marker in ART:Lamarca et al: HR Update; Vol 16, No: 2, Pages 113-130; 2010 Page 8
  9. 9. Biological Plausibility ofAndrogens in Folliculogenesis Page 9
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  13. 13. Greatest Challenge in ART…!!! 9-25% Page 13
  14. 14. Current trends of marriage and pregnancy Poor RespondersMaria et al. Ann. N.Y. Acad. Sci. 2008; 1127: 27–30, Gianaroli et al. Hum Reprod. 2010;25: 2374–2386, Schoolcraft et al. Fertil Steril. 2011 Sep; 96(3):638-40. Page 14
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  17. 17. Mild therapeutically well tolerated male hormone (85% in Adrenals & 15% in Ovaries) Page 17
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  19. 19. Wild Yam Extract Page 19
  20. 20. • Alzheimer’s Disease • Cervical Cancer • Infertility• Adrenal Insufficiency • Sexual Dysfunction• SLE • Chronic Fatigue• Depression Syndrome• Obesity • HIV/AIDS • RA • Psoriasis • Schizophrenia Page 20
  21. 21. •Recruitment of Dormant Follicles from Pool •Reduction of Apoptosis •Direct Effect on Granulosa Cells •Improved Mitochondrial Function Page 21
  22. 22. New Concept in Oocyte Aging(Barad & Gliecher – Submitted for Publication 2012) Recruitment of more “young “ – chromosomally competent oocytes by altering internal follicular milieu Quality of oocytes Quantity of oocytes Quality of embryos Decreased Miscarriage Rates Improved LBR Page 22
  23. 23. Age DHEA IGF-1Low Androgen Levels Reduction of ApoptosisPoor Meiotic Activation of GC & TC FunctionCompetence Improved Mitocondrial Function Improved Steroidal Milieu Recruitment of young oocytesPoor Quality Ooocytes Normal oocyte maturation Page 23
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  25. 25. Most common side effects…!!!More energized… Improved sexual drive… Page 25
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  27. 27. Since first-trimester placenta produces DHEA , maternal DHEA exposure atmoderate dosages in very early pregnancy should not constitute significant risk(Loganath, A., Peh, K.L., Wong, P.C., 2002. Evidence for the biosynthesis of DHEAfrom cholesterol by first trimester human placental tissue: source of androgens. Horm. Metab. Res. 34, 116–120.) Page 27
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  36. 36. 1. Is there a scientifically explainable basis?2. Does it harm?3. Do we have robust evidence in Questions other alternatives? to be4. Does it cause financial burden?5. What are deleterious effects of 3- asked??? 4 months delay in Rx ? Page 36
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  38. 38. Other Adjuvants Page 38
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  40. 40. Pre-Ovulatory Over-ripeness Ovopathy (PrOO Concept)MTHFR gene polymorphisms resulting in suboptimal oocyte maturation: a discussion of folate status, neural tube defects, schizophrenia, and vasculopathy ,Piet H et al; Jr of Experimental & Clinical Assisted Reproduction 2008, 5:5 Page 40
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  43. 43. •Delayed child bearing is the most important precipitating factor which increases the number of poor responders•Physiological rise in itnra-ovarian testosterone can be achieved with DHEA supplementation•Improved Ovarian Response to treatment can be expected with 3-4 months of DHEA in DOR •Robust evidences in terms of increasing LBR with DHEA treatment is still lacking•“ABSENCE OF EVIDENCE IS NOT EVIDENCE OF ABSENCE”•Role of CoQ10 & Folic acid in improving oocyte quality has to explored further Page 43
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