This document provides a clinical case involving a 33-year-old nulliparous obese woman presenting with irregular menses and weight gain who is being evaluated for infertility. It discusses definitions of infertility, common etiologies, advice for patients, and evaluation including day 21 progesterone testing. It also covers polycystic ovarian syndrome diagnosis and treatment involving ovarian stimulation and IVF.
a case study on urinary tract infection ( UTI) martinshaji
A case study on urinary tract infection , which gives a detailed study about UTI , the case study details about the treatment options , diagnosis , patient counselling , pharmacist interventions etc
Neonatal sepsis (sepsis on new born) with case presentationJOEL RAJAN U
Newborn sepsis is a severe infection in an infant younger than 28 days old. A newborn may become infected before, during, or after birth. Newborn sepsis can be hard to diagnose. Early diagnosis and treatment are the best ways to stop sepsis.
a case study on urinary tract infection ( UTI) martinshaji
A case study on urinary tract infection , which gives a detailed study about UTI , the case study details about the treatment options , diagnosis , patient counselling , pharmacist interventions etc
Neonatal sepsis (sepsis on new born) with case presentationJOEL RAJAN U
Newborn sepsis is a severe infection in an infant younger than 28 days old. A newborn may become infected before, during, or after birth. Newborn sepsis can be hard to diagnose. Early diagnosis and treatment are the best ways to stop sepsis.
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
Description of Urinary tract infections of pediatric age group, signs and symptoms, presentations, diagnosis, investigations, prognosis and management plan
MASTOCYTOSIS:
Is a group of rare disorders of both children and adults caused by the presence of too many mast cells (mastocytes) and CD34+ mast cell precursors in a person's body.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
Description of Urinary tract infections of pediatric age group, signs and symptoms, presentations, diagnosis, investigations, prognosis and management plan
MASTOCYTOSIS:
Is a group of rare disorders of both children and adults caused by the presence of too many mast cells (mastocytes) and CD34+ mast cell precursors in a person's body.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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.
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
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
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
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
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. MOHD
HANAFI
SURYA
SUPERVISOR: RAJ
DR. TAN NUGROHO MICHAEL
CIPTO RIYANTO WONG
ANGEL
KWAN
NUR
AINURA
CPC FATIN
AKMAL
3. HISTORY
• 33 | nullipara | obese
• Fertility | after 5 years marriage
• Menarche: 13 (regular)
• Currently: Irregular menses | Weight gain
• Day 2: FSH 3.5 mIU/ml | LH 5 mIU/ml
4. DEFINITION: INFERTILITY
Infertility
is defined as Primary happened
failure to Infertility in woman
conceive who has
after one never
year of conceived
unprotected
coitus at Secondary happened
frequent Infertility in a woman
intervals. who has
conceived
before
6. MALE: INFERTILITY ADVICES
– 2nd most common cause
– BMI > 29 may reduced fertility.
– increased scrotal temperature.
– excessive alcohol consumption
(NICE,2004).
– smoker’s sperm concentration is
on average 13-17% lower than
non-smokers. (Jenkins et. al 2003)
7. FEMALE: INFERTILITY ADVICES
– declines with age.
(NICE, 2004)
– Moderate weight loss (Health
Education Authority, 1996).
– limit their alcohol intake
(Jensen et al 1998).
– stop smoking (RCOG, 1998).
– Genital tract infection
(Winter and Ahmad, 1998)
12. WHAT IS PCOS
• Is a heterogenous disorder
affecting the
reproductive, endocrine and
metabolic systems.
• PCOS is often complicated by
chronic anovulatory infertility
and hyperandrogenism with the
clinical manifestation of
oligomenorrhoea, hirsutism
and acne
13. PATHOPHYSIOLOGY: PCOS
Genetically have insulin receptor disorder
and thus insulin resistance-
HYPERINSULINAEMIA
During puberty- GH spurt- IGF1 ↑↑
Hyperinsulinaemia+IGF1 cause ovarian
hyperstimulation
Ovarian hyperstimulation- cause thecal cell
hyperplasia and excessive androgen
production
14. PATHOPHYSIOLOGY: PCOS
HYPERINSULINAEMIA- also act on liver to reduce
sex hormone binding globulin (SHBG)- increase
free testosterone
Increased LH production by anterior pituitary relative
to FSH. Cause theca cell stimulation. Cyst formation
Follicles do not mature due to premature surge
in LH. Decreased FSH:LH cause inability of ovary
to convert androgen to estrogen.
15. HOW TO DIAGNOSE: PCOS
• Rotterdam criteria for diagnosis
• The diagnosis of PCOS requires the
exclusion of all other disorders that can
result in menstrual irregularity and
hyperandrogenism:
congenital adrenal hyperplasia
cushing syndrome
androgen secreting tumours
hyperprolactinaemia
16. HOW TO DIAGNOSE: PCOS
Rotterdam criteria for diagnosis
Two or more of the three following criteria:
• polycystic ovaries (either 12 or more peripheral follicles or
increased ovarian volume up to 10mm3)
1 • -via TVUS
• oligo- or anovulation (manifested as oligo- or amenorrhea)
2
• clinical and/or biochemical signs of hyperandrogenism.
3
17. CLINICAL AND/OR BIOCHEMICAL
SIGNS OF HYPERANDROGENISM
Clinical Biochemical
• Early sign-acne • Free serum
• Later develop testosterone
hirsuitism or level (not more
even male than 5nmol/L)
pattern alopecia
18. A raised luteinising hormone/follicle-
stimulating hormone ratio
(LH:FSH 2:1) is NO LONGER a
diagnostic criteria!!!!
19. SCENARIO
• Husband: Seminal fluid – severe
oligoasthenoteratoazoospermia
• Day 21 serum progesterone –
not ovulating
• Ovarian stimulating induction + IVF
20. PREPARATION: SEMEN SAMPLING
• Advice patient - abstinence from
sex and masturbation for 2 - 7
days prior
• collected in a private room near
the laboratory to limit the
exposure of the semen to
fluctuations in temperature and to
control the time between
collection and analysis
• semen sample needs to be
complete & should report any loss
of any fraction of the sample
21. COLLECTION: SEMEN SAMPLING
• obtained by masturbation and ejaculated
into a clean and wide mouthed container
• specimen container should be kept at
ambient temperature, between 20 C and
37 C
• placed on the bench or in an incubator (37
C) while the semen liquefies.
22. HOME: SEMEN COLLECTION
• Sample need to be completed. Report if
incomplete.
• Record the time of semen production
and sent to lab within 1H. Temperature
kept between 20 C and 37 C during
transport of sample
• Noted at report place of collection (home
/ outside the lab)
23. CONDOM: SEMEN COLLECTION
• Collected in a condom during sexual
intercourse
• Only special non-toxic condoms
designed used
• Information on how to use the
condom, close it, and send or
transport it to the laboratory.
• Record the time of semen production
and sent to lab within 1H. Temperature
kept between 20 C and 37 C during
transport of sample
• Noted at report place of collection
(home / outside the lab)
24. SEMEN ANALYSIS: WHO
Volume • > 1.5 mL
pH • ≥ 7.2
Total Sperm • 39 × 10^6 spermatozoa per
Number ejaculate
Sperm • 15 × 10^6 spermatozoa per ml
Concentration
25. SEMEN ANALYSIS: WHO 2010
• Sperm Motility :
– Progressive motility (PR): spermatozoa moving
actively, either linearly or in a large
circle, regardless of speed.
– Non-progressive motility (NP): all other patterns
of motility with an absence of progression, e.g.
swimming in small circles, the flagellar force
hardly displacing the head, or when only a
flagellar beat can be observed.
– Immotility (IM): no movement.
– Total motility (PR + NP) is 40%
– Progressive motility (PR) is 32%
26. SEMEN ANALYSIS: WHO 2010
• Sperm Vitality (membrane-intact
spermatozoa): 58% or more
• Sperm Normal Morphology (regular oval
head, with a connecting mid-piece and a long
straight tail): > 4%
27. NOMENCLATURE: WHO 2010
• Normozoospermia: total number of
spermatozoa, and % of progressively
motile (PR) and morphologically normal
spermatozoa ≥ lower reference limits
• Oligozoospermia: Total number of
spermatozoa <39 106 spermatozoa per
ejaculate or concentration of spermatozoa
<15 106 spermatozoa per ml
• Asthenozoospermia: Progressively motile
(PR) spermatozoa <32%
28. NOMENCLATURE: WHO 2010
• Teratozoospermia: < 4%
morphologically normal spermatozoa
• Azoospermia: No spermatozoa in the
ejaculate
• Aspermia: no semen (no or retrograde
ejaculation)
31. COMMENT ON THE
REASON OF USING
4 DAY 21
PROGESTERONE TEST
32. CRITERIA FOR TEST
1. Normal menstrual cycle
2. Length of menstrual cycle (28
days)
3. Not on hormonal therapy/OCP/
hormonal contraception
interfere normal hormonal
changes
4. If on OCP, stop at least 1 month
before test
35. - Normal Day 21 progesterone level in
functioning corpus luteum > 30ng/ml
- ↓ Day 21 progesterone level
Anovulatory cycles (no ovulation & no corpus luteum
formation to secrete the progesterone)
Abnormal menstrual cycle
Length of the menstrual cycle
On hormonal therapy/OCP/ hormonal contraception
37. INDICATIONS OF IVF
• Tubal problems: blocked or damaged
Fallopian tubes
• Severe endometriosis
• Pelvic inflammatory disease with
severe adhesion
• Male factor
• Unexplained infertility
38. COMPLICATIONS OF IVF
• IVF is basically a safe procedure.
• As with any medical or surgical procedure, a
few patients undergoing IVF treatment will
experience side effects and complications.
• The most common complications associated
with IVF treatment are the:
Failure of treatment The possibility of ectopic
pregnancy.
Ovarian hyperstimulation
Bladder, bowel injury and other
Multiple pregnancy, risk related to egg retrieval
39. WHAT IS IVF?
The steps of IVF are as follows:
• Ovulation Induction
• Retrieval
• Insemination of eggs and embryos culture
• Transferring embryos to the uterus
40. OVULATION INDUCTION
• optional if women can ovulate normally
• the stimulatory phase of an IVF cycle must begin
on the third day of the menstrual cycle.
• patients receive daily injections of gonadotropins
– hormones, which stimulate your ovaries to
produce multiple eggs.
• The ultimate goal of IVF stimulation is to achieve
the maximum number of mature follicles- eggs-
without over stimulation.
41. OVARIAN HYPERSTIMULATION SYNDROME
(OHSS)
Mild to Moderate
majority of women have a mild or moderate form of the
syndrome and invariably resolve within a few days unless
pregnancy occurs, that may delay recovery.
complain of pain, a bloated feeling and mild abdominal
swelling.
In a small proportion of women, the degree of discomfort
42. OVARIAN HYPERSTIMULATION SYNDROME
(OHSS)
Severe
Very rarely is severe and the ovaries are very swollen.
The woman will feel ill, with nausea and vomiting, abdominal pain.
Fluid accumulates in the abdominal cavity and chest, causing abdominal
swelling and shortness of breath. Reduction in the amount of urine
produced.
These complications require urgent hospital admission to restore the fluid
and electrolyte balance, monitor progress, control pain and in some very
serious cases, termination of pregnancy.
Complications associated with severe OHHS include blood clotting
disorders, kidney damage and twisted ovary (ovarian torsion).
43. CAUSES OF OHSS
Women with polycystic ovaries.
Over response to fertility drugs.
Young thin women.
High estrogen hormone levels and a large number of
follicles or eggs.
Administration of GnRh agonist.
The use of hCG for luteal phase support.
44. RETRIEVAL
When the eggs are
“ready”, that is, the majority Mature eggs will be collected
that we ask the male partner
of eggs are ripe for by ultrasound guided needle
to produce a semen sample
harvesting but they are not aspiration.
yet truly mature.
Retrieval is done after at
least 3 mature follicles of 18 It is at this time, shortly
This technique is performed
mm or more to produce a rafter the conclusion of the
in the office with IV sedation.
mature egg, a final injection egg retrieval,
must be taken.
minor surgical-Follicles are
located by ultrasound and
then a needle is guided
This final shot is called HCG.
through the vaginal wall into
the ovary to aspirate the
eggs from the follicles.
45.
46. INSEMINATION OF EGGS AND
EMBRYO CULTURE
ICSI IVF
intracytoplasmic sperm
injection In-Vitro Fertilisation
inject a single sperm into each egg. decision regarding the number of embryos to
transfer is not always easy
48 hours the fertilized eggs – now depends on such things as patient age, past IVF
called embryos – will be left alone in cycles and the quality of the embryos.
the incubator- for 3 to 5 days.
objective is to maximize the chance of pregnancy
the embryos will have been carefully while minimizing the chances of multiple
examined pregnancies.
47. TRANSFERRING EMBRYOS TO
UTERUS
the embryos will be transferred by placing very small
flexible catheter into your cervix and injecting the
embryos.
continue to take Progesterone (shots, pills or
pessaries)
A pregnancy test will be done 2 weeks after the
transfer
If the test is positive Progesterone shots are continued
as instructed (serum B-HCG).
48.
49.
50. 6TH WEEK AFTER IVF
• c/o lower abdominal pain associated with
per vaginal bleed for 2/7
• pain more marked on right side radiated
to the back
• vomited several times
• pain temporarily relieved by analgesia
51. ON EXAMINATION
• Blood pressure: 90/60 mmHg (↓)
• Pulse rate: 110 beats per minute (↑)
• Abdomen examination: tender on the
right iliac fossa (RIF) with no mass
palpable
• Vaginal examination: cervical os was
closed with some old blood seen on
posterior fornix
• Minimal cervical excitation and no
adnexal mass palpable
53. Ectopic pregnancy
• Pregnancy occurring in sites other than endometrium of the
uterus.
Threatened miscarriage
• Vaginal bleeding (usually fresh bleed and painless) with a closed
cervix prior to 22 weeks of pregnancy
Molar pregnancy
• Pregnancy in which a hydatid mole develops from the
trophoblastic tissue of the early embryonic stage of development
Impending miscarriage (inevitable)
• Onset of miscarriage process and will end as either complete,
incomplete or septic miscarriage
58. EVENTUALLY
• An emergency laparatomy was done and
found to have 2 litres of haemoperitonium
and ectopic pregnancy of right tube.
• Subsequently, right salphingectomy was
done and she was discharged after 3 days
from ward.
Male partner should be examine firstMen who have BMI> 29 may reduced fertility. avoiding increased scrotal temperature like wearing loose underwear, not to take hot bath and to avoid hot occupational environments. excessive alcohol consumption is detrimental to semen quality(NICE,2004). Jenkins et al 2003 said that smoker’s sperm concentration is on average 13-17% lower than non-smokers which is a concern for oligospermic men.
female fertility declines with age. Fertility falls steeply beyond 40 years of female’s age(NICE, 2004)women who have BMI>29 need to loose weight. Moderate weight loss may restore ovulation and improve pregnancy rates (Health Education Authority, 1996). limit their alcohol intake to one or two units once or twice per week so that the harm to the developing fetus can be reduced (Jensen et al 1998). Women who smoke should be advised to stop smoking as this improves her fertility and reduces the chances of miscarriage if she does conceive (RCOG, 1998). Genital tract infection with Chlamydia trachomatis is a major risk factor for subsequent tubal infertility (Winter and Ahmad, 1998)
The second rule is: Spread ideas and move people.
More than 5 free serum testosterone- must exclude adrenal androgen producing