Fallopian tube blockage
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The document discusses fallopian tube blockage, its causes such as pelvic inflammatory disease and endometriosis, and methods for testing and treating blocked tubes. Tests include hysterosalpingography (HSG), sonosalpingography (SSG), and laparoscopy, with laparoscopy being the most accurate but also invasive. Treatments involve medical management of underlying infections, surgical procedures like tubal flushing and recanalization, or in vitro fertilization (IVF) which has a higher success rate than tubal surgeries but is more expensive. The conclusion states that tubal testing is important for infertility evaluation but some tests are more accurate than others, and while tubal repair may work
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In this introductory remark at workshop on vaginal hysterectomy where Dr Shirish Seth was operating faculty.
I spoke “lets promote and propagate vaginal hysterectomy which is an indigenous surgery in line with PM Modi’s mission of MAKE IN INDIA.
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Let us not be driven by glamour,gadgets and gimmicks."
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This document discusses male infertility, including:
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Let us not be driven by glamour,gadgets and gimmicks."
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Strategies for improving success in Poor responders
Overcoming challenges associated with poor ovarian response is a critical aspect of in vitro fertilization (IVF) for individuals classified as poor responders. Various strategies can be employed to enhance the chances of success in this particular group of patients.
Firstly, individualized ovarian stimulation protocols play a crucial role. Tailoring medication dosages and adjusting the type of gonadotropins used based on the patient's age, ovarian reserve, and response to previous stimulation cycles is essential. Utilizing personalized approaches can optimize follicular development and improve egg yield.
Co-administration of adjuvant medications is another effective strategy. Growth hormone supplementation has shown promise in enhancing ovarian response and improving the quality of eggs in poor responders. Additionally, androgen pre-treatment has been explored as a means to improve ovarian function and response to stimulation.
Advancements in laboratory techniques, such as the use of time-lapse imaging systems, can aid in the selection of the most viable embryos for transfer. This ensures that the highest-quality embryos are chosen, increasing the chances of successful implantation.
Embryo transfer techniques also play a significant role in optimizing success for poor responders. Employing the assisted hatching technique or using preimplantation genetic testing (PGT) to screen embryos for chromosomal abnormalities can improve implantation rates.
In some cases, considering alternative approaches such as natural cycle IVF or minimal stimulation IVF may be beneficial for poor responders. These protocols aim to work with the patient's natural cycle or use lower doses of medications to reduce the risk of overstimulation and improve egg quality.
Furthermore, addressing lifestyle factors that may impact fertility, such as nutrition, stress management, and adequate sleep, is crucial for optimizing outcomes in poor responders.
In conclusion, a multifaceted approach is essential for improving success in poor responders undergoing IVF. By customizing ovarian stimulation protocols, incorporating adjuvant medications, leveraging advanced laboratory techniques, optimizing embryo transfer, and considering alternative protocols, fertility specialists can enhance the chances of a positive outcome for individuals facing the challenge of poor ovarian response.
Embryo Transfer- Tips and Tricks to improve success
Improving embryo transfer technique is crucial in the field of assisted reproductive technology (ART) as it significantly influences the success of in vitro fertilization (IVF) procedures. A well-executed embryo transfer is vital for the optimal implantation of embryos, leading to a higher likelihood of a successful pregnancy. Here are several key strategies to enhance the embryo transfer technique:
Firstly, proper training and skill development for the fertility specialist or clinician performing the procedure are essential. Training programs that emphasize hands-on experience and guidance from experienced practitioners contribute to proficiency in embryo transfer. Continuous professional development ensures that practitioners stay updated on the latest advancements in the field.
Secondly, utilizing ultrasound guidance during embryo transfer enhances precision. Real-time visualization enables the clinician to accurately navigate the catheter through the cervix and deposit the embryos in the ideal location within the uterine cavity. This minimizes the risk of trauma and increases the chances of successful implantation.
Maintaining a relaxed and comfortable environment during the procedure is equally important. Studies suggest that minimizing stress and anxiety in both the patient and the clinician can positively impact the success of embryo transfer. This involves effective communication with the patient, addressing any concerns, and ensuring a supportive atmosphere in the clinic.
Optimizing the timing of embryo transfer concerning the woman's menstrual cycle is another critical factor. Synchronization between the embryo's developmental stage and the endometrial receptivity is vital. Personalized protocols and careful monitoring of hormonal levels contribute to better timing, enhancing the chances of successful implantation.
Lastly, considering individualized patient factors, such as uterine anatomy and the woman's overall health, is essential. Tailoring the embryo transfer technique to the specific needs of each patient increases the likelihood of a positive outcome.
In conclusion, continuous education, technological advancements, personalized approaches, and a patient-centered focus are key elements in improving the embryo transfer technique. Implementing these strategies can contribute to higher success rates in IVF procedures, bringing hope to individuals and couples seeking to build their families through assisted reproductive technologies.
The Thin endometrium- Where are we today?
The thin endometrium refers to the lining of the uterus, known as the endometrium, being insufficiently thick. This condition is typically characterized by a reduced thickness of the endometrial layer, which plays a crucial role in supporting the implantation and development of a fertilized egg during the menstrual cycle.
A thin endometrium is commonly associated with hormonal imbalances, such as low estrogen levels, which are vital for the growth and maintenance of the endometrial tissue. Inadequate blood flow to the uterus, chronic inflammation, or certain medical conditions can also contribute to this condition. Women with a thin endometrium may experience difficulties in achieving and maintaining pregnancy, as the thin lining may not provide an optimal environment for the embryo to implant and thrive.
Addressing the underlying causes of a thin endometrium often involves hormonal therapies to regulate estrogen levels, lifestyle modifications, and sometimes surgical interventions. Fertility treatments, such as in vitro fertilization (IVF), may be considered to overcome the challenges associated with a thin endometrium.
In conclusion, a thin endometrium can pose challenges to fertility and reproductive health, requiring a comprehensive approach to address the underlying factors and improve the chances of successful conception.
Preimplantation Genetic Testing - Dr Kaberi Banerjee
Preimplantation Genetic Testing for Aneuploidy (PGT-A), formerly known as preimplantation genetic screening (PGS), is a technique used during in vitro fertilization (IVF) to screen embryos for chromosomal abnormalities before implantation. Like any medical procedure, PGT-A has both advantages and disadvantages.
Pros of PGT-A:
Reduced Risk of Aneuploidy: PGT-A helps identify embryos with chromosomal abnormalities, such as aneuploidy, which can reduce the risk of implantation failure, miscarriage, and certain genetic disorders.
Improved IVF Success Rates: By selecting embryos with the correct number of chromosomes, PGT-A can enhance the chances of a successful implantation and a healthy pregnancy, leading to improved overall IVF success rates.
Reduced Miscarriage Rates: Identifying and transferring embryos with the correct chromosomal makeup may decrease the likelihood of spontaneous miscarriages, particularly in older women who are at a higher risk of producing embryos with chromosomal abnormalities.
Family Planning for Genetic Disorders: PGT-A allows couples at risk of transmitting specific genetic disorders to screen embryos for these conditions, enabling them to make informed decisions about which embryos to implant.
Cons of PGT-A:
No Guarantee of Pregnancy: PGT-A does not guarantee a successful pregnancy. Other factors, such as uterine receptivity, can still impact the success of embryo implantation.
False Positives and Negatives: PGT-A is not foolproof, and false positives and negatives can occur. In some cases, embryos identified as abnormal may be viable, leading to the potential discarding of healthy embryos, or vice versa.
Invasive Nature: The procedure involves removing a small number of cells from the developing embryo, which some argue could potentially harm the embryo, although the impact is generally considered minimal.
Financial Cost: PGT-A adds an additional cost to the already expensive IVF process. The financial burden may be a significant consideration for some couples, especially if insurance does not cover the expense.
Limited Scope: PGT-A primarily screens for numerical chromosomal abnormalities and may not detect all genetic disorders or structural chromosomal abnormalities. Additional testing, such as preimplantation genetic testing for monogenic disorders (PGT-M) or preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR), may be necessary for a more comprehensive assessment.
In summary, while PGT-A offers potential benefits in terms of reducing the risk of aneuploidy and improving IVF success rates, it is essential for couples to weigh these advantages against the potential drawbacks and consider their individual circumstances, including the financial and emotional aspects of the procedure.
Endometrial Receptivity Array- Dr Kaberi Banerjee
The endometrial receptivity array (ERA) is a diagnostic tool used in assisted reproductive technology (ART) to assess the receptivity of the endometrium, or the lining of the uterus, during the implantation window. While ERA has shown promise in improving the chances of successful embryo implantation, it also comes with its own set of advantages and disadvantages.
Pros of Endometrial Receptivity Array (ERA):
Personalized Timing: ERA helps determine the optimal window of endometrial receptivity for a specific woman. This personalized approach aims to synchronize the embryo transfer with the most favorable conditions for implantation, potentially improving the chances of successful pregnancy.
Reduced Pregnancy Loss: By accurately identifying the receptive window, ERA may contribute to reducing the risk of implantation failure and early pregnancy loss, especially in cases where previous IVF cycles were unsuccessful.
Improved Treatment Precision: ERA provides a more precise understanding of the individual's endometrial cycle, allowing fertility specialists to tailor the timing of embryo transfer to maximize the likelihood of success. This personalized approach may be particularly beneficial for women with irregular menstrual cycles.
Enhanced Cost-Efficiency: While the initial cost of an ERA test is an additional expense in the IVF process, the potential for increased success rates and reduced need for repeated embryo transfers may lead to cost savings in the long run.
Cons of Endometrial Receptivity Array (ERA):
Limited Evidence: Some critics argue that there is limited conclusive evidence supporting the routine use of ERA in all IVF cycles. The effectiveness of ERA is still a topic of ongoing research, and its widespread adoption may require more comprehensive validation.
Additional Cost: The ERA test adds an extra cost to the already expensive IVF process. Some couples may find it financially burdensome, especially if insurance coverage does not include this diagnostic procedure.
Invasive Nature: The endometrial biopsy required for the ERA test is an invasive procedure that may cause discomfort and pose a slight risk of infection or bleeding. However, the risks are generally minimal.
Time Consumption: The time required for the ERA test may extend the overall duration of the IVF process, which can be a concern for couples seeking a more expedited fertility treatment.
In conclusion, while the endometrial receptivity array offers potential benefits in improving IVF success rates through personalized timing, its adoption should be carefully considered based on individual circumstances, including financial considerations and the need for further research on its long-term efficacy.
Single Embryo Trasnfer- Dr Kaberi Banerjee
Single embryo transfer (SET) is a reproductive technique employed during in vitro fertilization (IVF) that involves transferring only one embryo into the uterus. This approach has both advantages and disadvantages, influencing the decision-making process for couples and fertility specialists.
Pros of Single Embryo Transfer (SET):
Reduced Multiple Births: One of the primary benefits of SET is the significant reduction in the occurrence of multiple pregnancies, such as twins or triplets. Multiple pregnancies are associated with higher risks for both the mother and the babies, including preterm birth and low birth weight.
Enhanced Pregnancy Success Rates: Focusing on transferring a single embryo allows for better control and optimization of the conditions for implantation. This can result in higher success rates per transfer, increasing the likelihood of a healthy pregnancy.
Lower Risk of Complications: Single embryo transfers minimize the risk of complications associated with multiple pregnancies, such as gestational diabetes, preeclampsia, and cesarean section. This can lead to better maternal and neonatal outcomes.
Cost Savings: Although the initial cost of IVF is not necessarily reduced with SET, the long-term costs associated with caring for multiple preterm infants and potential complications are significantly lower.
Cons of Single Embryo Transfer (SET):
Lower Pregnancy Rates per Cycle: While SET can result in higher success rates per transfer, the overall pregnancy rates per IVF cycle may be lower compared to transferring multiple embryos. This can be a concern for couples with limited resources or time.
Potential Need for Multiple IVF Cycles: Achieving pregnancy with SET may require multiple IVF cycles, extending the time and financial investment for couples trying to conceive.
Emotional Stress: The uncertainty of success with each cycle can contribute to emotional stress for couples undergoing fertility treatments, particularly if they experience multiple unsuccessful attempts.
Age-Related Factors: For older women with diminished ovarian reserve, transferring a single embryo may further reduce the chances of success. In such cases, the decision to transfer multiple embryos may be considered based on individual circumstances.
In conclusion, the choice between single and multiple embryo transfer in IVF involves weighing the potential benefits of a healthy, singleton pregnancy against the desire for higher success rates and faster conception, considering the unique circumstances of each couple.
Chronic endometritis and its effect on Fertility
Chronic endometritis, inflammation of the endometrial lining, may hinder fertility by disrupting the implantation process. Early diagnosis and treatment are crucial for optimizing reproductive outcomes and addressing infertility challenges.
Cleavage vs Blastocyst- Dr Kaberi Banerjee
"Embryo Transfer Strategies: Cleavage vs. Blastocyst"
Brief overview of the significance of embryo transfer in assisted reproductive technologies (ART) and the focus on cleavage and blastocyst stages with their merits and demerits.
Transforming Reproductive Medicine with AI
"Transforming Reproductive Medicine with AI"
Brief overview of the impact of AI on various fields, leading into its applications in reproductive medicine.
Pitfalls of PGTa
The document discusses preimplantation genetic testing for aneuploidy (PGT-A), which screens embryos for chromosomal abnormalities during in vitro fertilization (IVF) treatment. It notes that while PGT-A is purported to improve live birth rates and reduce miscarriage risks, two recent large randomized controlled trials found no significant benefits. A study analyzed in the document found PGT-A to be not cost-effective due to the high costs associated with preventing one miscarriage. Overall, the document concludes that the current evidence is insufficient to support the routine use of PGT-A in clinical practice.
Elective Single Embryo Transfer- An Insight
This document provides guidelines for elective single embryo transfer (eSET) compared to double embryo transfer (DET) following in vitro fertilization (IVF). It finds that while the cumulative live birth rate is lower for eSET than DET, eSET significantly reduces the risk of multiple pregnancies. The guidelines recommend eSET for good prognosis patients aged 35 or younger in their first or second IVF attempt with at least 2 good quality embryos. This is intended to minimize twin pregnancies while maintaining acceptable live birth rates overall.
CLEAVAGE OR BLASTOCYST EMBRYO TRANSFER
This document discusses the debate around whether embryo transfer should occur at the cleavage stage (day 3) or blastocyst stage (day 5-6).
It summarizes a study that found transferring embryos at the blastocyst stage resulted in a significantly higher ongoing pregnancy rate compared to cleavage stage in patients aged 35 or older, but no difference was seen in younger patients. The cumulative ongoing pregnancy rate was also higher but not significantly for blastocyst transfers.
The document also discusses some potential risks of blastocyst culture and transfer, including increased rates of preterm birth and large babies. Some studies found higher risks of congenital anomalies and epigenetic issues with blastocyst transfers as well.
Overall,
Why Not Era
This study evaluated the endometrial receptivity array (ERA) test in patients with recurrent implantation failure. The study found:
- Of 2110 patients with moderate recurrent implantation failure, those who underwent embryo transfer of euploid embryos after preimplantation genetic testing for aneuploidy (PGT-A) had higher implantation and ongoing pregnancy rates than those without PGT-A.
- For 488 patients with severe recurrent implantation failure, no statistically significant improvements were seen with PGT-A.
- The use of the ERA test did not significantly improve outcomes for either group.
- PGT-A may be beneficial for moderate recurrent implantation failure cases but not severe cases.
-
Evaluation of Quality of Life in Infertile Couples
This study evaluated the quality of life of 600 infertile couples in India. The authors found that infertility caused stress and depression in many participants. Specifically:
- 40% of women and 37.5% of men reported issues with night sleep, while day sleep was less affected.
- Most participants reported feeling stressed due to infertility and social pressures. Women reported higher rates of stress than men.
- Around 69% of women and 52% of men experienced depression.
- Infertility had little impact on marital relationships for most couples.
The authors concluded that infertility is a stressful life event for many couples, affecting sleep and mental health, though social support from partners can help mitigate some negative impacts on quality of life
Management of IVF Pregnancy
This document summarizes a panel discussion on the management of IVF pregnancies conducted by Delhi ISAR, Advance Fertility and Gynaecology Centre, and Madhukar Rainbow Group of Hospitals. The panelists provided expert opinions on topics like the choice of ART treatment, number of embryos to transfer, luteal phase support, anomaly screening, reduction of higher order multiples, antenatal follow-up, prevention of preterm labor, use of antenatal steroids, and delivery timing in twin pregnancies. The document emphasizes that IVF pregnancies require special care and management.
Psychosocial & Ethical Dilemma Surrounding Fertility Preservation in Young Ca...
Dr. Kaberi Banerjee is a renowned fertility specialist in India. She has over 8000 IVF and fertility cases and has received several national and international awards for her work. The document discusses the psychosocial and ethical issues surrounding fertility preservation in young cancer patients. It emphasizes the importance of counseling patients on their fertility options upon cancer diagnosis and coordinating care between oncologists and fertility specialists. Key considerations include obtaining proper consent for fertility preservation procedures in minor patients and addressing the ethical issues around experimental procedures, posthumous use of stored reproductive tissues, and risks to potential offspring.
Myoma in Infertility Dilemmas in Management
This document provides information about Dr. Kaberi Banerjee, a medical director and chairperson in Delhi, India. It outlines her qualifications and experience in obstetrics, gynecology, and reproductive medicine. The document then discusses myomas (fibroids) and their relationship to infertility, outlining various diagnostic and treatment options for managing fibroids, including hysteroscopic resection, medical therapy, uterine artery embolization, and focused ultrasound surgery. Key considerations in treatment selection include fibroid location, size, number, and patient desire for future fertility.
Role of Subcutaneous G-CSF Infusion in Thin Endometrium
Subcutaneous administration of granulocyte colony-stimulating factor (G-CSF) helped improve endometrial thickness and pregnancy rates in patients with thin endometrium undergoing ART cycles. In a study of 107 patients, those who received subcutaneous G-CSF (Group 1) in addition to sildenafil and aspirin had a significantly higher pregnancy rate of 59% compared to 27% for those who only received sildenafil and aspirin (Group 2). G-CSF works by increasing endometrial decidualization and proliferation. The study provides initial evidence that subcutaneous G-CSF may have a promising role in improving fertility outcomes for thin endometrium cases. Larger studies are still
Medically Complicated IVF Patient
Dr. Kaberi Banerjee is a renowned fertility specialist in India. She has over 8000 IVF cases and has received several national and international awards for her work. She discusses medically complicated IVF patients who have medical disorders that can affect fertility or aggravate during treatment. These include hypertension, diabetes, heart disease, epilepsy, blood clots, endocrine disorders, cancers, lupus, HIV, and obesity. For each condition, she outlines how it impacts fertility, any pre-IVF preparation needed, and management during ovarian stimulation and pregnancy to optimize outcomes.
Dilemmas in Management of Fibroid
This document provides information about Dr. Kaberi Banerjee, a medical director and chairperson in Delhi, India. It outlines her qualifications and experience in obstetrics, gynecology, and reproductive medicine. The document then discusses myomas (fibroids) and their relationship to infertility, outlining various diagnostic and treatment options for fibroids including hysteroscopic myomectomy, abdominal myomectomy, laparoscopic myomectomy, morcellation, medical management, uterine artery embolization, MRI-guided focused ultrasound, and vaginal occlusion of uterine arteries.
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Fallopian tube blockage
- 1. What is Fallopian Tube Blockage Dr. Kaberi Banerjee Medical Director, Advance Fertility and Gynaecology Centre Delhi and Noida www.advancefertility.in
- 2. Normal Fallopian Tube Function www.advancefertility.in
- 3. Causes of Blocked Fallopian Tubes • Pelvic inflammatory disease • Endometriosis • Ectopic Pregnancy • Fibroids • Past abdominal surgery • Tubal Ligation www.advancefertility.in
- 7. HSG vs Laparoscopy HSG • Less expensive • No need of GA • Painful • Errors in Reporting • Screening Test • Only Tubal Flushing • Cannot treat any other pathologies Laparoscopy • Expensive • Invasive • GA • Accurate • Gold Standard • Corrective Procedures • Useful for PCOS, Endometriosis etc www.advancefertility.in
- 8. Treatment of Blocked Tubes- Medical www.advancefertility.in • Pelvic Inflammatory Disease Treatment • Anti tubercular Treatment
- 9. Treatment of Blocked Tubes- Surgical www.advancefertility.in • Tubal Flushing • Adhesiolysis • Tuboplasty • Tubal Recanalization
- 10. Treatment of Blocked Tubes- IVF www.advancefertility.in
- 11. IVF vs Tuboplasty IVF • Expensive • Many times • More Successful • Less chances of Ectopic • More appropriate in cases of advanced age and male factor Tuboplasty • Less Expensive • One time • Only Successful in few cases • More chances of Ectopic • More appropriate in younger women with no other associated factor www.advancefertility.in
- 12. Conclusion • Tubal tests are an important part of evaluation of infertility • Not all tests have same amount of accuracy • Laparoscopy is invasive but gold standard and also be corrective at times • Tubal repair is successful in few cases • IVF is the final answer in Tubal infertility www.advancefertility.in