2014: What's new in Reproductive Medicine?

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Every day, there is something new that may or may not have an impact on our daily practice. In this talk , we want to highlight some of these new developments

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2014: What's new in Reproductive Medicine?

  1. 1. What’s New??? Reproductive Medicine Gana Hospital
  2. 2. Why!!! • To be updated • To modify • To share
  3. 3. Progesterone
  4. 4. Brain  Progesterone can be produced in the brain from steroid precursors.  they have been found to have neuroprotective function.
  5. 5. Progesterone for acute brain trauma
  6. 6. Progesterone & Preterm labor Mainly for prevention of preterm labor But still there are many preterm labor Liable to cerebral palsy and delayed neural development
  7. 7. Idea Progesterone after preterm labor For the preterm baby
  8. 8. Why To protect the fetal brain To improve brain development
  9. 9. Preterm fetus: Deprived from P4
  10. 10. Trottet et al, 2012 First case preterm baby having progesterone therapy Future
  11. 11. Genomic Sequencing The coming Era
  12. 12. DNA sequencing • Rapidly evolving • Allow genetic diagnosis of diseases • Allow prediction for disease later in life • Determine human genome in details Now Next generation Sequencer
  13. 13. Work flow of conventional versus second- generation sequencing
  14. 14. 1. Prepare genomic DNA 2. Attach DNA to surface 3. Bridge amplification 4. Fragement become double stranded 5. Denature the double stranded molecules 6. Complete amplification • Illumina • ABI SOLiD • Roche 454 • HeliScope What is next-generation sequencing ?
  15. 15. 7. Determine first base 8. Image first base 9. Determine second base 10. Image second base 11. Sequence reads over multiple cycles 12. Align data. 1 billion bases per run, 1% of the cost of capillary-based method.
  16. 16. Preimplantation Genetic Diagnosis (PGD)
  17. 17. Which Embryo is Disease-Free?
  18. 18. Non Invasive Prenatal Diagnosis • Minimise the need for amniocenecis • Cell free DNA (fetal in maternal blood) • High accuracy
  19. 19. Towards Better Gene Therapy
  20. 20. Spindle transfer !!!!! • spindle-chromosomal complex transfer • taking nuclear DNA from an egg cell and transferring that DNA into another egg cell, leaving the defective mitochondrial DNA behind • For genetic disease • Safety?????? Gene therapy
  21. 21. Back to Simple Ideas
  22. 22. High dose FSH at hCG triggering • Novel concept • Give four ampoules of FSH at time of hCG injection • Why??????
  23. 23. LH surge is associated with FSH surge to a lesser extent
  24. 24. Outcome?? •10% increase in PR??
  25. 25. Corifolitropin alfa • Long acting FSH • Under the name of Elonva • Single shot • Contraindicated with PCOS • Not self administered • Not cheaper
  26. 26. Increasing LBR with Diagnostic Hysteroscopy
  27. 27. Dienogest • 19-nortestosterone derivative • Endometriosis • Menorrhagia • COC • Pituitary suppression
  28. 28. DNG in endometriosis • no glucocorticoid • no antimineralocorticoid activity. • no antiestrogenic activity • due to DNG's low gonadotropic activity, E2 levels are not decreased to zero, in contrast to treatments with gonadotropin-releasing hormone (GnRH) analogues.
  29. 29. COC • This maintenance beneficial E2 effects is of particular importance for the general tolerability of the first contraceptive pill to use E2V instead of EE • safer??
  30. 30. Ulipristal acetate & Fibroids • oral selective progesterone receptor modulator (SPRM) that has successfully completed phase III clinical trials. • licensed in Western Europe • has shown efficacy with a significant reduction in uterine bleeding, fibroid volume, and improved quality of life • low side effects unlike (GnRH) agonists.
  31. 31. Thank you Professional Diploma in Reproductive Medicine

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