This document discusses different approaches to managing infertility or delayed conception. It advocates for a rapid, active management approach that completes investigations and establishes a diagnosis within 1 month. This accelerated approach aims to help couples facing age-related fertility declines. It outlines investigations that can be completed within a woman's first cycle, including blood tests, imaging and ovulation monitoring. If needed, treatments like timed intercourse, IUI or IVF would be conducted over successive cycles, with the goal of achieving pregnancy within 1 year before more invasive or complex treatments. The document argues this rapid approach is preferable to standard or expectant management methods that can prolong the process and reduce chances of success.
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
Hyvinvoinnin ja terveyden edistämisen päivässä Tampereella 6.10.2016 (THL). Vastaava koulukuraattori Hanna Gråsten-Salonen (Tampereen kaupunki).
Grasten salonen
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
Hyvinvoinnin ja terveyden edistämisen päivässä Tampereella 6.10.2016 (THL). Vastaava koulukuraattori Hanna Gråsten-Salonen (Tampereen kaupunki).
Grasten salonen
Dr Steve McGloughlin is an intensivist at the Alfred Hospital. He is also an infectious diseases specialist and maintains both clinical and research interests in infections in critically ill patients. Here he discusses the ongoing primacy of antibiotics in intensive care and our continuing battle with antibiotic resistance
The statutory guidance 'Keeping Children Safe in Education' published in April 2014, asks schools to ensure that they raise awareness of Female Genital Mutilation (FGM). Staff should be aware of FGM and it should be included in your school's safeguarding policy where the different types of abuse and neglect are set out.
Female Genital Mutilation occurs mainly in Africa and to a lesser extent, in the Middle East and Asia. Although it is believed by many to be a religious issue, it is a cultural practice. There are no health benefits.
Communities particularly affected by FGM in the UK include girls from:
Somalia, Kenya, Ethiopia, Sierra Leone, Sudan,
Egypt, Nigeria, Eritrea, Yemen, Indonesia and Afghanistan.
In the UK, FGM tends to occur in areas with larger populations of communities who practise FGM, such as first-generation immigrants, refugees and asylum seekers. These areas include:
London, Cardiff, Manchester, Sheffield, Northampton,
Birmingham, Oxford, Crawley, Reading, Slough and Milton Keynes.
In England and Wales, 23,000 girls under 15 could be at risk of FGM.
Key issues:
Not a religious practice
Occurs mostly to girls aged from 5 - 8 years old; but up to around 15
Criminal offence in UK since 1985
Offence since 2003 to take girls abroad
Criminal penalties include up to 14 years in prison
Automotive Systems course (Module 05) - Preheating Systems for vehicles with ...Mário Alves
This presentation describes some of the most important systems that enable the correct operation of Internal Combustion Engines. More specifically, we browse Diesel preheating systems, involving the control of Glow Plugs that preheat the combustion chamber at engine cranking and warm up, as well as intake air and fuel heating systems.
PowerPoint presentation on ECMO (Extracorporeal Membrane Oxygenation). Part 2 focuses on Monitoring ECMO patients
Ventilatory strategies, Sedation and pain control, Weaning, Complications and recent advances in ECMO. For better understanding please have a look at ECMO part 1 before going through part 2.
Varies Ranges : from 0 to 150 mm Wc up to 0 to 600 Bar
Differential (Dead Band) : Fixed (Within 10% of set value)
Temperature Range : -10 to 80 Degree C (for high temperature use of impulse tube is advisable)
Accuracy : +/- 1% to 2% FS
No. of Switches : one no. or, two nos.
Type of Switches : Micro Switches - SPDT
Sensing Element : Diaphragm (PTFE or Neoprene or SS 316) or Piston
Enclosure : Dustproof IP 40, Weatherproof to IP 54 / IP 65 / IP 66, Flameproof
presentation on infertility, causes and its management. it gives an idea of the scope of the problem especially in sub Saharan Africa . the challenges in its management.
Explain the wider meaning of family planning.
Give contraceptive counselling.
List the efficiency, contraindications and side effects of the various contraceptive methods.
List the important health benefits of contraception.
Advise a postpartum patient on the most appropriate method of contraception.
Challenges - In management of infertilityDrRokeyaBegum
Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive.
Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.
INFERTILITY AND ITS MANAGEMENT IS A LIGHTNING TOPIC OF OBSTETRICS AND GYNAECOLOGY. ALL THE METHODS OF INFERTILITY MANAGEMENT ARE DISCUSSED IJN THIS SLIDE.
There are many ethical aspects which derive from the application of reproduction control in women's health. Women's health can be enhanced if women are given the opportunity to make their own reproduction choices about sex, contraception, abortion and application of reproductive technologies.
The effort to find out which one is better abortion or childbirth, relate it to Islamic teaching and conventional law. sorry for any kind of mistake/wrong.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. • This Lecture explains my personal opinion
• In spite that this lecture contains medical
evident informations
• If you accept this lecture,
take it as a science
• If you do not accept it,
take it as a fun
3. • Infertility is faliure of a couple to concieve
with continous coitus without use of
contraception
for one year if (primi ) age below 35y
for two year if (multi ) age below 35y
For six monthes if age above 35y
For immediate if age above 40 y
• Delayed Conception is faliure of a couple to
concieve with continous coitus without use of
contraception
When they or one of them come to complain at any
time
(may be infertility or before it )
4. • most newly married couples are asked
sometimes even as soon as they have returned from the
honeymoon !
• There is a lot of pressure on couples to have a baby,
especially in traditional families, where the wife's role
is still seen to be one of perpetuating the family name
by producing heirs.
• Many couples still naively expect they will get
pregnant the very first month they try ( the result of
watching too many films , perhaps !) - and are
concerned when a pregnancy does not occur.
• All of us go through a brief interlude of doubt and
concern when we do not achieve pregnancy the very
first month we try and we start wondering about our
fertility.
5. Warning over delayed conception
• Women who spend a long time unsuccessfully trying for
a baby could face problem births once they do finally
become pregnant.
The finding, from Danish researchers, applies equally to
natural conceptions and those due to fertility treatment.
A total of 56,000 births were analysed - thsoe conceived
after more than a year of trying were more likely to be
born early or need caesarean section.
The study was published in the journal Human Reproduction.
6. The properties of the fecund male
include
1) Normal spermatogenesis and ductal system
(normal count, motility, and biologic
structure/function
2) Ability to transmit the spermatozoa to the female
vagina, through :
• - Adequate sexual drive
• - Ability to maintain an erection
• - Ability to achieve a normal ejaculation
• - Placement of ejaculate in the vaginal vault
7. The properties of the fecund female
include
• 1) Adequate sexual drive and sexual function to permit coitus
• 2) Functioning reproductive anatomy and physiology which includes:
- A vagina capable of receiving spermatozoa
- Normal cervical mucus to allow passage of
spermatozoa to the upper genital tract
- Ovulatory cycles
- Fallopian tubes which will function to permit the sperm and ovum
to meet and allow migration of the conceptus to the uterus
- A uterus capable of developing and sustaining the conceptus to
maturity
- Adequate hormonal status to maintain pregnancy
• 3) Normal immunologic responses to accommodate sperm, conceptus,
and fetal survival.
• 4) Adequate nutritional, chemical, and health status to maintain
nutrition and oxygenation of placenta and fetus
8. FERTILITY AND DURATION OF
MARRIAGE FOR
COUPLES WITHOUT
CONTRACEPTION
• 25% of pregnancies occur within 1 month
• >60% of pregnancies occur within 6 months
• 75% of pregnancies occur within 9 months
• 80% of pregnancies occur within 12 months
• 90% of pregnancies occur within 18 months
9. While women under age 30 have
approximately a 20 percent per month
chance of conceiving, only 5 percent of
women over age 40 will conceive
• The fertility potential of the average woman begins to
decline appreciably at the age of 35 years, and begins to
decline dramatically beyond the age of 40 years
• The biggest obstacle most women over 40 face is two-fold:
- diminishing ovarian reserve
- coupled with poor embryo quality (the phenomenon of
chromosomal aneuploidy )
10. the effects of paternal age on a
couple's fecundity
• They are real and may be greater than previously believed.
• After adjustment for other factors, the probability that an
ultimately fertile couple will take >12 months to conceive
nearly doubles from ~8% when the man is <25 years to
~15% when he is >35 years
• paternal age is a further factor to take into account when
deciding the prognosis for infertile couples.
• What Age Does to Sperm
• Decreased Motility
• Decreased Strength
• Decreased Potency
• Altered Genetic Make-Up
11. • Infertility is faliure of a couple to concieve
with continous coitus without use of
contraception
for one year if (primi ) age below 35y
for two year if (multi ) age below 35y
Six monthes if age above 35y
immediate if age above 40 y
• Delayed Conception is faliure of a couple to
concieve with continous coitus without use of
contraception
When they or one of them come to complain at any
time
(may be infertility or before it )
12. 3 Methods Of Management
Rapid ( Active ) Or standard Or
Expectant management Of Delayed
Conception Or Infertility
1 - Rapid ( Active management) in 1 year
2 - standard management ( EBM )
3 - Expectant management in years ( old )
13. Expectant management Of Infertility
Infertility is always an important problem for the patient
but never an urgent one.
The general attitude is one of “let’s wait and watch” and
let “Nature take its own course”.
Since many couples and doctors know of patients who have
conceived naturally after many years of previously
fruitless marriage,
they commonly adopt this attitude
This approach was acceptable in the past, when there was
so little we could offer in any case for these couple.
14. When a couple or one of them come to me
complaining of delayed coneption
of any time
• I explain to them or one of them that there is 2
methods of management
1 - Rapid ( Active management) in 1 year
2 - standard management
and I let them to choose after my explaination
16. Rapid ( Active ) management Of Delayed
Conception Or Infertility
• It is worthwhile drawing an analogy to the current
management of labour and childbirth.
• In older days, when no drugs were available, doctors
were often forced to wait and watch.
• They could do little to intervene and it was common for
labours to last for over 2-3 days often resulting in
stillbirths and even maternal deaths.
• With the advent of drugs like oxytocin and
prostaglandins, all that has changed!
• Obstetricians now take an active approach to provide a
favourable outcome in a quicker time frame.
17. • Today, unfortunately, the investigation and
management of infertility still leaves a lot to be desired.
• It is often slow, time-consuming and costly. The
infertile couples are seldom seen together.
• Investigations are performed in a piecemeal fashion
rather than as part of an overall strategy.
• Doctors are also keen to “do something” and repeated
curettages and laparoscopies (done unnecessarily) are a
common feature in the medical history of these hapless
couples.
• Also, myomectomies may be performed for small
fibroids; ovarian cystectomy and wedge resections done
for simple ovarian cysts which should have been left well
alone; as well as “uterine ventrisuspension” when all else
fails.
• These procedures commonly induce adhesions and
damage a previously normal pelvis.
18. • Both patient and doctor suffer from the inefficient
treatment of this problem.
• The doctor feels inadequate and unable to help his
patient, and trust between the doctor and patient breaks
down.
• The temptation to try many empirical, possibly useless
medical treatments is considerable; and patients often
end up spending large sums of monies at the hands of
quacks and “spiritual healers”.
• This is why taking an active success-oriented approach
to infertility is important today.
• The couple must be seen together and treated as a unit.
The workup to establish a diagnosis should be completed
in 1 months.
• The timing of the procedures is important, and we have
found the following strategy cost-effective.
19. Why active is preferable !!
Active Versus Standard And Expectant Management
• 1. Couples today marry at an older age.
Their biological time clock is running out
and we often need to accelerate events
we cannot sit back and wait and watch.
• 2. Effective treatment is available today to enhance
Nature’s efficiency
(or rather its inefficiency in the case of these
couples).
This treatment must be judiciously employed, to give
couples their best chance.
20. Age-related decline in fertility
• A decrease in the number and health of the eggs to
be ovulated.
• A decrease in sperm counts.
• A decrease in the frequency of intercourse.
• The presence of other medical and gynecologic
conditions, such as endometriosis, which may
interfere with conception.
21. • in less than 15 - 30 days ! They just need to make 3
visits to the clinic, thus saving a lot of time, money
and energy.
• a detailed medical history from the couple, and also
performs a physical examination for both of them, to
determine if this can provide clues as to the cause of
the problem.
22. Investigations
Start at the time which they come in it and regulate other times to end
all these investigation in 15 - 30 days
• Semen analysis (during the wife’s menstrual period)
• FSH, LH, TSH, Prolactin Blood Tests ( at third day from beginning
of cycle)
• Hysterosalpingogram ( at Fifth - seventh day from beginning of
cycle)
• Vaginal Ultrasound For Ovulation Monitoring And Assessing
Endometrial Thickeness And Texture ( at eleventh - sixteenth day
from beginning of cycle)
• Serum Progesterone Level For Ovulation ( at twenty-one day from
beginning of cycle)
23. Some doctors will perform further testing
during the rest of the month, though we
rarely do these tests in our own practise
• They include: ultrasound scans for ovulation monitoring
between Day 11-16 ; and the scan results can be used for
timing the PCT (postcoital test) as well, during which time
the cervical mucus is assessed also.
. Some doctors will also performed a laparoscopy in the same
month (Day 20-25) ; and combine it with an endometrial
biopsy , if desired
24. Treatment
• All these ttt takes only one year
• Timed intercourse, 6 cycles;
• Intrauterine insemination (IUI)- 4
cycles;
• Superovulation with HMG plus IUI -3
cycles;
• then IVF or GIFT. Don’t waste time!
As a rule of thumb, if a treatment is
going to work, it should work in 4
cycles.
25. • While no one can predict what the out-come
of treatment is going to be for any infertile
couple,
• at the end of it all,
• they should at least have the satisfaction of
knowing that they tried everything that was
possible.
26. What is your Opinion???
1 - Rapid ( Active management)
2-standard management
3 - Expectant management