The document summarizes key points from a presentation on modern ovarian physiology and IVF protocols. It discusses topics like ovarian reserve evaluation using basal FSH, AMH and AFC; the effect of FSH receptor polymorphisms on ovarian response; ovulation induction protocols using GnRH agonists versus antagonists; and strategies for OHSS prevention including coasting or freezing all embryos. It provides an overview of the speaker's approach to stimulation including use of a step-down protocol and recommendations on FSH dose based on patient age. Results from the speaker's clinic show good outcomes with low OHSS rates.
Silverberries is IVF center in pune,conducts IVF treatments with assisted reproductive technology to treat infertility problems in men and women. Visit us @ http://www.silverberriesivf.com/
Azoospermia is defined as the absence of spermatozoa in the ejaculate or simply absence of sperms in semen. Azoospermia accounts for about one fifth of all cases of male infertility and in 10-20 % of abnormal Semen Reports.
Silverberries is IVF center in pune,conducts IVF treatments with assisted reproductive technology to treat infertility problems in men and women. Visit us @ http://www.silverberriesivf.com/
Azoospermia is defined as the absence of spermatozoa in the ejaculate or simply absence of sperms in semen. Azoospermia accounts for about one fifth of all cases of male infertility and in 10-20 % of abnormal Semen Reports.
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
Management of poor ovarian reserve- Dr Parul KatiyarDr Parul Katiyar
Premature ovarian aging or ovarian failure is a major cause of female factor infertility. Dr Parul explains the mechanism of premature ovarian failure and discusses some simple measures to preserve/ regain fertility among women.
Ovulation induction protocols for unexplained infertility new advances 2019 f...Anu Test Tube Baby Centre
What are the new advances in assisted reproductive technologies with respect to ovulation induction for unexplained infertility ? - Intra uterine insemination (IUI) and in vitro fertilization (IVF)
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
Management of poor ovarian reserve- Dr Parul KatiyarDr Parul Katiyar
Premature ovarian aging or ovarian failure is a major cause of female factor infertility. Dr Parul explains the mechanism of premature ovarian failure and discusses some simple measures to preserve/ regain fertility among women.
Ovulation induction protocols for unexplained infertility new advances 2019 f...Anu Test Tube Baby Centre
What are the new advances in assisted reproductive technologies with respect to ovulation induction for unexplained infertility ? - Intra uterine insemination (IUI) and in vitro fertilization (IVF)
LH activity for Gonadotrphin in controlled ovarian hyperstimulation : LH or j...Hesham Al-Inany
LH like activity is claimed to be of importance for COH in IVF/ ICSI cycles. is this real. Does addition of LH make GN more superior? this talk may answer this
prophylactic encerclage for multiple pregnancy is always debated.in this presentation cerclage for MFG is favored as there was a debate in recently held KSOGA conference at manipal on 3-11-11.
Presented by Gunta Lazdane, Programme Manager, Sexual and Reproductive Health, WHO/Europ , at the 64th session of the WHO Regional Committee for Europe.
Delhi IVF Fertility & Research Centre in IndiaDelhi IVF
Delhi-IVF Fertility & Research Centre in India was established in the year 1994 by Dr. Anoop Gupta (an expert consultant and specialist in infertility management) together with a small and dedicated team committed to provide the best fertility care, IVF, Surrogacy, Egg Donation and Infertility Clinic in India.
Menopause: how to balance your hormones and live vibrantlyVandna Jerath, MD
Vandna Jerath, MD discusses menopause, hormonal imbalance, how to balance hormones, and living vibrantly for a health seminar at Parker Adventist Hospital in Parker, CO. She outlines a number of treatment modalities including hormone replacement therapy (HRT), bioidentical hormone replacement therapy (BHRT), and alternative therapy. She reviews the latest women's health updates related to menopause and vulvovaginal atrophy as well as her current practice usage of BioTE hormone pellet therapy and MonaLisa Touch vaginal laser revitalization treatment.
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
a presentation about what is new in the management of some important complications such as poor ovarian reserve, poor responder , over responder and ovarian hyperstimulation syndrome
Ovarian stimulation for assisted reproductive technology(ART) cycle aims to provide multiple pre-ovulatory follicles for oocyte collection.
The components of a conventional ART cycle-
Induction of multi-follicular growth with exogenous gonadotropins.
Prevention of endogenous leutinizing hormone (LH) surge by using Gonadotropin releasing hormone(GnRH) analogs.
inducing endogenous LH surge or mimicking it with exogenous human chorionic gonadotropin(hCG) for oocyte maturation.
This concept is known as “CONTROLLED OVARIAN STIMULATION”
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Infertility affects as many as 10% of the couples, the causes, investigations and treatment with mention of management of fibroids and endometriosis has been done in the presentation.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Focus Points
1. Ovarian Modern Physiology
2. Ovarian Reserve Evaluation
3. Basal Testosterone
4. Ovulation induction: Long Protocol
5. Embryo Transfer
6. Luteal Phase Support
7. OHSS management
8. Results
3. Modern Physiology
• Modern Physiology of the menstrual cycle
• Recruitment (window)
• Recruitment in induced cycles
• Polimorfism of FSH receptors
• Ovarian Response
6. Polymorphism of FSH
Receptors
FSHr Receptors – cromossome 2
Inactivating Mutations
○ Hipotalamic Amenorrea
○ Primary: homozygous
○ Secondary: heterozigous
○ Premature Ovarian failure
Activating Mutations
○ Spontaneous OHSS
○ Increase sensibility to FSH/HCG/TSH
○ Normal Espermatogênesis in the absense of
FSH
7. Effect of FSHr in natural
cycle
P4
SER
ASN
FSH
M
E2 < in cases with FSH
8. Ovarian Response
ASN (Asparginine)
< number of follicles
Define cycle lenght
Decrease of negative E2 feedback
Recruitment increase
Cycle lenght increase
Higher FSH Treshold
SER (Serine)
> follicle number
At least less 30 cycles
OBS: PCR determination
9. Polimorfism of FSH Receptors
• The stimulation response depends of FSH receptors performance
• Homozigose
• Asn-Asn – Poor response (homozigous)
• Asn-Ser – Normal (heterozigous)
• Ser-Asn – Normal (heterozigous)
• Ser-Ser – Hi responder (homozigous)
10. Basic Concepts
• 50% From those with poor response
wil have porro response at the first cycle
• 50% increase the response in the second
cycle with the same stimulation protocol
• 70% will have better performance in the second cycle
12. Ovarian Reserve Evaluation: Basal FSH
• When measure? : Cycle Day 3
• Always measure estradiol to avoid false negatives
• Can vary from cycle to cycle
• One alteraded value- poor prognosis
• Elevated FSH (>15)- Response almost never change
14. AMH
Produced by Granulosa céls
From follicle primary to antral
Low or no dependence to FSH
Best ovarian age marker
< AMH can have precocious menopause
AMH not change with sequencial cycles
22. Androgens and Follicular
Stimulation
Synergic action of Testosterone with FSH
Prolonged Ovulation Stimulation
Association with small follicles
Can predict the ovarian response
23. Suplementation
Testosterone
Testogen
○ Poor responder
○ During 15-20 days
○ Without significative disfunction
○ No effect in:
Number of basal follicles
Mature follicles
Oocytes
Embriyos
Pregnancy rate
29. LH
Before the cycle
300 IU/day
Bloqueia com Triptorelina Depot
200 UI FSH dia
HCG com fol > 12 mm
Reduz risco de SHO
Dim. número de folículos pequenos
30. GH Hormônio do
Crescimento
• Cochrane Review
• Without impact on stimulation parameters:
• E2 Peak
• Stimulation Lenght
• Gonadotrophins Requirements
• Only 3 studies reported births
31. Oral Contraceptives
• Previous use to the cycle
• At least 15 days
• Bleeding occurs between 48 and 72h
• Stimulation must start between days 1 and 5
• Endocrinology alteration
• Follicle growth rate alterated
• Increase in FSH dose
• Increase in stimulation lenght
32. Luteal Phase Supression
GnRHant: Crash
D23 ou 25 D2
Gonadotrophins
Short protocol
• GnRHant supress previous cycle stimulation
• Luteólisys
3.0 g GnRHant
33. CRASH Protocol
• Less than 35 years
• Poor responder
• Basal FSH normal
• Luteólisys with GnRHant
• Short protocol
35. LH During the cycle
Indications:
> 35 years
Suboptimal response to FSH
How Much LH?
○ 75 UI
○ LH ceiling = atresia (> 375 UI)
○ Filicori used 200 UI without problems
Use in Hipogonadotrófic/Hipogonadism
37. LH
LH alto no day8 – aum abortamento
Triptorelina
Leuprolida
Buserelina
Nafarelina
Incremento
na potência
do antagonista
Potência
confunde
Bosch 2008: > 35 anos
• Com e sem LH
• Taxa de gravidez igual
• Tx de implantação igual
• Taxa de abortamento igual
38. LH use:
• Earlier:
• Increase Androgen synthesis
• Stimulates the Recruitment
• Late
• Physiological Manutention
• Increase of E2 synthesis
• Control of the follicular growth
40. OVULATION INDUCTION
GnRH Agonist
Individualised Dose FSH rec®
1
Lupron®
1.0 mg/day/for 14 days
0.5 or 1.0mg / day
150/225 IU
per day
day1
of FSH rec®
Day7
of FSH rec® HCG rec®
day21
Down regulation
Long Protocol
41. Why only two Ultrassound
exams?
• First Exam day 7:
• Follicle count
• Follicle Measurement
• Endometrium classification
• Endometrium measure
42. Why only two Ultrassound
exams?
• Second Exam day 10 or 11:
• Follicle count
• Follicle Measurement (Growth rate)
• Endometrium classification
• Endometrium measure
• Calculate the HCG day
43. Follicular Cohort
• Same cohort per patient
• Dose independent
• Less is more
• Actual recommendations:
• < 30 years 150 IU/day
• > 30 years 225 IU/day
44. LESS IS MORE
• Lower Dose of FSHr:
• Smaller Cohort
• More Syncrony
• Higher number of MII
• Less incidence of Aneuploidy
• Higher Fertilization Rate
• Higher Pregnancy Rate
Increased gonadotrophin stimulation does not improve IVF
outcomes in patients with predicted poor ovarian reserve
Dharmawijaya N Lekamge & Michelle Lane &
Robert B Gilchrist & Kelton P Tremellen
45. Less Than 30 years
• Low Responders: Upgrade to 30/37 years protocol
• Normal Responders:
• Gonal-F 150 IU for seven days
• Step-down to 75 IU
• Keep untill the day before HcG
• High Responders:
• Gonal-F 150 IU for 3 days
• Step-down to 75 IU
• Keep untill the day before HcG
46. From 30 to 37 years
• Low Responders: Upgrade to >37 years protocol
• Normal Responders:
• Gonal-F 225 IU for seven days
• Step-down to 150 IU (one day)
• Step-down to 75 IU
• Keep untill the day before HcG
• High Responders:
• Gonal-F 225 IU for 3 days
• Step-down to 150 IU (day 4)
• Step-down to 75 IU
• Keep untill the day before HcG
47. More Than 37 years
• Low Responders: Do not Upgrade the dose
• Normal Responders:
• Gonal-F 300 IU for seven days
• Step-down to 225 IU (one day)
• Step-down to 150 IU (one day)
• Step-down to 75 IU
• Keep untill the day before HcG
• High Responders:
• Gonal-F 300 IU for 3 days
• Step-down to 225 IU (day 4)
• Step-down to 150 IU (day 5)
• Step-down to 75 IU
• Keep untill the day before HcG
48. Why use Step-down
Protocol?
• Respect the Physiology
• Avoid the second cohort recruitment
• Prevent Assincrony
• More Mature follicles
49.
50.
51. Why choose Agonist
Protocol?
• Better response
• Possibility to use almost fix protocol
• Less FSHr dose
• Less Assincrony
• Less Aneuploidy
• Higher number of mature eggs (MII)
• Higher Fertilization Rate
• Less incidence of moderate OHSS (2%)
• Higher Pregancy Rate
52. Almost Fixed Protocol ?
START
Gonadotrop
hins
US
Day 7
US Day
10 or
11
hCG Ovum
Pickup
Transfer
Day 3
Transfer
Day 5
Saturday Friday Monday Tuesday Thursday Sunday Tuesday
Wednesday Friday Monday Wednesday
Wednesday Tuesday Friday Saturday Monday Thursday Saturday
Tuesday Friday Monday Wednesday
Never :ovum pick-ups on Saturdays or Sundays
Sometimes: Embryo Transfer on weekends
60. OHSS (Old)
• Coasting: maximun 2 days
• Renin/angiotensin Blockers:
• Dostinex 1 pill/VO/day/7 days
• Losartana 10 mg 1 pill/VO/day/7 days
+
• Enalapril 8 mg ½ pill/VO/2x day/ 7 days
• Quinagolide 100 mg 1 cp/VO/day/ 7 days
61. OHSS (New)
• Normal Ovum Pickup
• Presence of Symptoms:
• Ovarian enlargement
• Slow Intestinal transit.
• Ascitis
• Frezze All (Eggs or Embryos)
• Aplication of 4 Cetrotide Syringes (At the same time)
• Regression of the symptoms in 4 days
• Transfer in the next cycle
• OHSS incidence : 2% of the cycles