This document discusses various Assisted Reproductive Technologies (ART) including their processes, types, and indications. Some key ART procedures summarized are:
- In vitro fertilization (IVF) which involves retrieving eggs from a woman and fertilizing them with sperm in a lab before embryo transfer.
- Intrauterine insemination (IUI) which places increased sperm concentrations directly into the uterus to bypass cervical barriers.
- Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) which involve manipulating eggs or zygotes in the fallopian tubes.
- Intracytoplasmic sperm injection (ICSI) which injects a
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)Muhammad Anas Shamsi
Assisted reproductive technology (ART) is used to treat infertility. It includes fertility treatments that handle both a woman's egg and a man's sperm. It works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body. In vitro fertilization (IVF) is the most common and effective type of ART.
i. Intrauterine insemination (IUI).
ii. In vitro fertilization and embryo transfer (IVF and ET).
iii. Gamete intra-fallopian transfer (GIFT).
iv. Zygote intra-fallopian transfer (ZIPT).
v. Intra-vaginal culture (IVC).
vi. Cytoplasmic transfer (CT).
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)Muhammad Anas Shamsi
Assisted reproductive technology (ART) is used to treat infertility. It includes fertility treatments that handle both a woman's egg and a man's sperm. It works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body. In vitro fertilization (IVF) is the most common and effective type of ART.
i. Intrauterine insemination (IUI).
ii. In vitro fertilization and embryo transfer (IVF and ET).
iii. Gamete intra-fallopian transfer (GIFT).
iv. Zygote intra-fallopian transfer (ZIPT).
v. Intra-vaginal culture (IVC).
vi. Cytoplasmic transfer (CT).
The cause of infertility may be difficult to determine but may include inadequate levels of certain hormones in both men and women, and trouble with ovulation in women.
Maternal and Neonatal morbidity and MortalityBPKIHS
It deals with:
Introduction
International Perspectives
National Status
Complication during Pregnancy, Childbirth, Postpartum period including Neonatal Problems
Causes of Maternal and neonatal mortality
Framework of determinants of maternal mortality
Three delay model
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
The cause of infertility may be difficult to determine but may include inadequate levels of certain hormones in both men and women, and trouble with ovulation in women.
Maternal and Neonatal morbidity and MortalityBPKIHS
It deals with:
Introduction
International Perspectives
National Status
Complication during Pregnancy, Childbirth, Postpartum period including Neonatal Problems
Causes of Maternal and neonatal mortality
Framework of determinants of maternal mortality
Three delay model
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
Assisted reproductive technology (ART) is a medical procedure used to address infertility issues.It involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and/or the use of fertility medication.
Learning disabilities are neurologically-based processing problems. These processing problems can interfere with learning basic skills such as reading, writing and/or math.
Mania is a facet of type I bipolar disorder in which the mood state is abnormally heightened and accompanied by hyperactivity and a reduced need for sleep.
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.
Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.
Adolescence, transitional phase of growth and development between childhood and adulthood. The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19.
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints.Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.
Head injuries are one of the most common causes of disability and death in adults. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone, or from internal bleeding and damage to the brain.
A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.Both result in parts of the brain not functioning properly.
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of diseases resulting in a change either temporary or permanent, in its normal motor, sensory or autonomic function.
In 1911, Eugen Bleuler, first used the word "schizophrenia."The word schizophrenia does come from the Greek words meaning "split" and "mind," & refers to the way that people with schizophrenia are split off from reality; they cannot tell what is real and what is not real.
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.
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.
Follow us on: Pinterest
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
2. Introduction
• Assisted reproductive technology (ART) refers to any fertility
treatment in which gametes (sperms and ova) are manipulated.
• It is all treatments or procedures that include in vitro handling of
both human oocytes and sperm or embryos for the purpose of
establishing a pregnancy.
• ART include IVF, ICSI, gamete intrafallopian transfer (GIFT),
zygote intra-fallopian transfer (ZIFT), cryopreserved embryo
transfers, and use of donor oocytes.
3. Contd..
• IVF is the most common ART procedure.
• It was first successfully used by Steptoe and
Edwards leading to birth of Louise Brown in
1978.
• Since then many births have been achieved, with
world over using this and other related ART
procedures.
4. Types of ART
• Intra Uterine Insemination (IUI)
• In-vitro Fertilization (IVF)
• Gamete Intra-Fallopian Transfer (GIFT)
• Zygote Intra-fallopian Transfer (ZIFT)
• Intracytoplasmic sperm injection (ICSI)
• Ovum and Sperm Transfer
• Surrogate mother
5. Process of ART
o Follicle growth
o Oocyte maturation/ovulation triggering
o Oocyte retrieval
o Luteal support
o Fertilization by IVF or ICSI
o In vitro embryo culture
o Transfer of fresh embryos
o Cryopreservation of surplus embryos
o First trimester pregnancy monitoring
6. INTRA UTERINE INSEMINATION
(IUI)
• IUI may be either AIH (artificial insemination
husband) or AID (artificial insemination donor).
• Husband’s semen is commonly used.
• Purpose of IUI is to bypass endocervical canal which
is abnormal and to place increased concentration of
motile sperm as close to fallopian tubes.
7. Contd..
Technique
o Washing, swim-up and centrifugation methods are
commonly used.
o Washing in culture media removes proteins and
prostaglandins from semen that may cause uterine cramps .
o Centrifugation recovers most highly motile as well as
morphologically normal sperm.
o Swim-up method selects most motile sperm.
8. Contd..
• Motile sperm count for insemination should be at least 1
million. Best results are obtained when motile sperm count
exceeds 10 million.
• Fertilizing capacity of sperm is for 24-48 hours.
• Procedure may be repeated 2–3 times over a period of 2–3
days.
• Generally 4–6 cycles of insemination with superovulation is
advised.
10. Indications
• Hostile cervical mucus
• ™
Cervical stenosis
• ™
Oligospermia or asthenospermia
• ™
Immune factor (male and female)
• ™
Male factor—impotency or anatomical defect
(hypospadias) but normal ejaculate can be obtained
• ™
Unexplained infertility
11. Timing of IUI
• Natural cycles
o Cervical mucus study, BBT
chart, urine LH surge
o lUI × 2, likely on day 12 and
14
• ™
Clomiphene induced cycles
– lUI - hand 7 days after
completion of CC
• ™
Urinary LH detection
– lUI - 24 hours after color
change
• ™
Use of hCG and sonography
– hCG at 18 mm diameter of the
follicle
– lUI × 2, following 34–40 hours
of hCG administration
12. IN VITRO FERTILIZATION AND
EMBRYO TRANSFER (IVF-ET )
• 1st described by Patrick Steptoe and Robert Edwards
of England, with birth of Louise Brown in 1978 by
IVF-ET.
• IVF consists of retrieving a preovulatory oocyte from
ovary by transvaginal ultrasonography guided
laboratory, with subsequent fertilized egg (embryo)
transfer within endometrial cavity.
13. • Usually transfer of embryo is done 2-5 days after
fertilization through fine flexible soft catheter
transcervically.
• Not more than 3 embryo is transferred per cycle to
minimize multiple pregnancy.
• Luteal phase support is provided by progesterone
supplementation.
14. Results:
• Overall delivery rate varies from 25-35% per oocyte
retrieval.
• Increased risk of miscarriage (18%)
• Multiple pregnancy (31%)
• Ectopic (0.9%)
• Low birth weight baby and prematurity.
• Risk of congenital malformation of baby remains similar to
general population.
15. Indications
• Tubal disease
• Unexplained infertility
• Endometriosis
• Male factor infertility
• Multiple factors (female and
male)
• Failed ovulation induction
• Ovarian failure (Donor oocyte
IVF)
• Women with normal ovaries but
no functional
• uterus (Müllerian agenesis)
• Women with genetic risk
16.
17. GAMETE INTRAFALLOPIAN
TRANSFER (GIFT)
• GIFT was first described by Asch and colleagues in 1984.
• It is a more invasive and expensive procedure than IVF
but result seems better than IVF.
• Procedure consists of ovarian stimulation, monitored
follicular development, and oocyte aspiration as similar to
IVF. But for GIFT procedure patient must have at least 1
normal appearing and patent fallopian tube.
18. • In this procedure, both motile sperm (2-5 lakh) and
2 unfertilized oocytes are transferred into fallopian
tubes. Fertilization is then achieved in vivo.
• Main drawback: It dose not allow for visual
conformation of fertilization.
• Result: Overall delivered pregnancy rate is as high as
27–30 %.
21. ZYGOTE INTRAFALLO PIAN
TRANSFER (ZIFT)
• Zygote intrafallopian transfer was first described by Devroey
et al. (1986).
• This procedure is a combination of IVF and GIFT.
• During ZIFT, oocytes are retrieved similar to IVF and GIFT
and they are allowed to fertilize in vitro in the laboratory as in
IVF.
22. • Placement of zygote (following one day of in vitro
fertilization/2 cell stage) into fallopian tube can be done
either through abdominal ostium by laparoscope or
through uterine ostium under ultrasonic guidance.
• Indication
• Male factor of infertility conformed
• Failed of GIFT
23.
24. Intracytoplasmic sperm injection
(ICSI)
• ICSI was first described by van Steirteghem and
colleagues in Belgium (1992).
• ICSI is an invitro fertilization procedure in which a
single sperm is injected directly into cytoplasm of an
oocyte by micropuncture of zona pellucida.
• This procedure is carried out under a high quality
inverted operating microscope.
25.
26. • Sperm is recovered from ejaculate. Otherwise sperm
is retrieved by TESE (testicular sperm extraction) or
by MESA (microsurgical epididymal sperm
aspiration) procedures.
• Result: Fertilization rate is about 60–70%. Pregnancy
rate is 20–40% per embryo transfer.
27.
28. • Indication
• Severe oligospermia (5 million sperm/mL)
• Asthenospermia, teratospermia
• Presence of sperm antibodies
• Obstruction of efferent duct system (male)
• Congenital absence of vas (bilateral)
• Failure of fertilization in IVF
29. Surrogacy
• Surrogacy is an arrangement, often supported by a
legal agreement, whereby a woman (surrogate
mother) agrees to bear a child for another person,
who will become child's parent(s) after birth.
30. Types of Surrogacy
A) Traditional surrogacy
A traditional surrogacy (also known as partial, natural, or straight
surrogacy) is one where surrogate's egg is fertilized in vivo by
intended father's or a donor's sperm.
B) Gestational Surrogacy:
Gestational surrogacy (also known as host or full surrogacy). It takes
place when an embryo created by in vitro fertilization (IVF)
technology is implanted in a surrogate.
It is also called a gestational carrier.
31. • Indications
o abnormal uterus
o a complete absence of a uterus either congenitally or post-
hysterectomy.
o Past implantation failures, history of multiple miscarriages,
o High risk pregnancy such as severe heart or renal diseases
o biological impossibility of single men and same-sex couples
having a baby
32. Cryopreservation /Ovum & sperm
bank
• It is process of keeping embryos, sperms and tissues
from ovaries in extremely low temperature (at -196°
under liquid nitrogen) in lab for restoration of
fertility in future .
• There are 3 types of Cryopreservation : Sperm
Freezing, Egg and Ovarian Tissue Freezing, Embryo
Freezing.
33. Health Hazards of ART
• Multiple births.
• Birth defects
• Premature delivery and low birth weight.
• Ovarian hyperstimulation syndrome.
• Miscarriage by using of frozen embryos
34. • Egg-retrieval procedure complications i.e. bleeding, infection
or damage to the bowel, bladder or a blood vessel.
• Ectopic pregnancy
• Psychological stress and anxiety of couple are severe. It is
especially so when there is failure in the treatment or with a
pregnancy loss.
