Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
Endometriosis and Subfertility, Primium non nocereSujoy Dasgupta
Dr Sujoy dasgupta and Dr Arun Madhab Barua were invited to moderate a panel discussion on "Endometriosis and Subfertility, Primium non nocere" in the International Congress on Endometriosis (ICE) on 10 December 2023 at Dhana Dhanya Auditorium, Kolkata
Endometriosis and Subfertility - What to do?Sujoy Dasgupta
Lecture delivered by Dr Sujoy Dasgupta in IPCON 2823, the Mid term conference of ISOPARB (Indian Society of Perinatology and Reproductive Biology) held at Kolkata on 10 September
Management of Endometrioma- Current UpdateSujoy Dasgupta
Invited Lecture by Dr Sujoy Dasgupta in the Webinar on "Update on Endometriosis" organized by AICC RCOG (All India Coordinating Committee of Royal College of Obstetricians and Gynaecologists) East Zone, held in December, 2021
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in an invited debate through a webinar organized by Dr B. N. Chakraborty School of Fertility Management and research, held in July, 2020
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in the invited debate on “Surgery is the ONLY treatment of Endometriosis with Infertility” in the Webinar organized by the AICC RCOG (All India Coordinating Committee) East Zone held in February, 2022
Endometriosis and Subfertility, Primium non nocereSujoy Dasgupta
Dr Sujoy dasgupta and Dr Arun Madhab Barua were invited to moderate a panel discussion on "Endometriosis and Subfertility, Primium non nocere" in the International Congress on Endometriosis (ICE) on 10 December 2023 at Dhana Dhanya Auditorium, Kolkata
Endometriosis and Subfertility - What to do?Sujoy Dasgupta
Lecture delivered by Dr Sujoy Dasgupta in IPCON 2823, the Mid term conference of ISOPARB (Indian Society of Perinatology and Reproductive Biology) held at Kolkata on 10 September
Management of Endometrioma- Current UpdateSujoy Dasgupta
Invited Lecture by Dr Sujoy Dasgupta in the Webinar on "Update on Endometriosis" organized by AICC RCOG (All India Coordinating Committee of Royal College of Obstetricians and Gynaecologists) East Zone, held in December, 2021
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in an invited debate through a webinar organized by Dr B. N. Chakraborty School of Fertility Management and research, held in July, 2020
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in the invited debate on “Surgery is the ONLY treatment of Endometriosis with Infertility” in the Webinar organized by the AICC RCOG (All India Coordinating Committee) East Zone held in February, 2022
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Dr Sujoy Dasgupta was invited to deliver a lecture on "Male Infertility, Antioxidants and Beyond" on 3 February in Yuvacon 2024 organized by the Bengal Obstetric and Gynaecological Society (BOGS). The session was supported by UNS.
More Related Content
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Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Similar to Fertility Management: Synergy between Endoscopists and Fertility Specialists (20)
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Dr Sujoy Dasgupta was invited to deliver a lecture on "Male Infertility, Antioxidants and Beyond" on 3 February in Yuvacon 2024 organized by the Bengal Obstetric and Gynaecological Society (BOGS). The session was supported by UNS.
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in an invited debate FOR the motion "Radical excision of DIE in subferile women with deep infiltrating endometriosis is not recommended" in ENDOGYN 2024, organized by the IAGE (Indian Association of Gynaecological Endoscopists) and the BOGS (Bengal Obstetric and Gynaecological Society) on 10 February 2024.
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
Invited lecture by Dr Sujoy Dasgupta in the Ultrasound Workshop of the Annual National Conference of Indian Association of Gynaecological Endoscopists (IAGE) held on 15 March 2024 at the Taj Ganges, Varanasi
Invited lecture by Dr Sujoy Dasgupta on "Azoospermia - Evaluation and Management" in a CME on "Standardising Male Factor Evaluation" organised by Indian Fertility Society (IFS) on 20 January 2024.
Are we giving much importance to AMH in infertility practice?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered "Kamini Rao Oration" on "Are we giving much importance to AMH in infertility practice?" in East Zone Yuva FOGSI Conference organized by Imphal Obstetric and Gynaecological Society (IOGS) on 24 December, 2023
Male Infertility-How a Gynaecologist can Manage?Sujoy Dasgupta
Dr Sujoy dasgupta delivered an invited lecture on "Male Infertility-How a Gynaecologist can Manage?" in a CME on "New Frontiers in Infertility" organized by Genome Fertility Centre and Bhagirathi Neotia Woman and Child Care Centre, Kolkata held on 15 December 2023
Dr Sujoy Dasgupta delivered an invited talk on "Embryo Transfer" in "Ultrasound Workshop" on 8 December 2023 at Milan, 2023, the conference of all the Obstetric and Gynaecological Societies of West Bengal. This conference was organized by Kalyani Obstetric and Gynaecological Society (KOGS).
Rational Investigations and Management of Male InfertilitySujoy Dasgupta
Dr Sujoy Dasgupta delivered an invited lecture in the annual conference of WMOGS (West Midnapore Obstetric and Gynaecological Society) held on 16 September, 2023
IVF- How it changed the perspective of Male InfertilitySujoy Dasgupta
Dr Sujoy Dasgupta was invited to deliver a talk in a CME held on the World IVF Day (25 July, 2023) organized by Burdwan Obst Gynae Society and Corona Remedies.
Male Infertility- How Gynaecologists can manage?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered an invited lecture in a CME organised by JB Pharma with the support from West Midnapore Obst and Gynae Society and Genome Fertility Centre held at Medinipur on 22 July, 2023.
Role of Multivitamins & Antioxidants in Managing Male Infertility Sujoy Dasgupta
Dr Sujoy Dasgupta was invited to deliver a talk on "Role of Multivitamins & Antioxidants in Managing Male Infertility " in a CME organized by Agartala Obstetric and Gynaecological Society and ArEx Laboratory held at Agartala on 8 July 2023
Panel discussion moderated by Dr Sujoy Dasgupta and Dr Sudip Basu on "Troubleshooting in Male Subfertility" in the Andrology Workshop organized by Special Interest Group (SIG) Andrology and Indian Fertility Society (IFS) West Bengal Chapter held on 11 June 2023 at Kolkata
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
Invited lecture by Dr Sujoy Dasgupta on "Abnormal Semen- What Next" in a CME organized by HBC Life Sciences on "Fertility and Beyond" held on 28 April 2023
Oration delivered by Dr Sujoy Dasgupta at Yuvacon, conference organized by the BOGS (Bengal Obstetric and Gynaecological Society) held on 22-23 April, 2023
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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!
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
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.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Fertility Management: Synergy between Endoscopists and Fertility Specialists
1. Synergy between Endoscopists and
Fertility Specialists
Moderators
• Sujoy Dasgupta
• Tanuka Das Gupta
Panelists
• Avishek Bhadra
• Indranil Saha
• Manas Dutta
• Paramita Hazari
• Shovan Deb Kalapahar
Expert
• Abhinibesh Chatterjee
2. Dr Sujoy Dasgupta
MBBS (Gold Medalist, Hons)
MS (OBGY- Gold Medalist)
DNB (New Delhi)
MRCOG (London)
Advanced ART Course for Clinicians (NUHS, Singapore)
M Sc, Sexual and Reproductive Medicine (South Wales, UK)
Consultant: Reproductive Medicine, Genome Fertility
Centre, Kolkata
Managing Committee Member, BOGS, 2022-23
Executive Committee Member, ISAR Bengal, 2022-24
Clinical Examiner, MRCOG Part 3 Examination
Winner, Prof Geoffrey Chamberlain Award, RCOG World
Congress, London, 2019
3. www.aicog2023.co
DR.TANUKA DAS
CONSULTANT GYNAECOLOGIST &
OBSTETRICIAN
MBBS,MS,DNB,MRCOG,FMAS
Peerless Hospital ,kolkata & Freelancing
endoscopic surgeon
Specialization
Fellowship in advanced Laparoscopy (Pauls
Hospital,Kochi)
Training at Lap advanced retroperitoneal
dissection .(Dr Limbachiya,ahmedabad)
Training of Lap Urogynaecology
(SHIMIST,sonipat)
Trained in transvaginal Ultrasound
4. Dr. Avishek Bhadra
MBBS (Gold Medalist), MS (Gold Medalist),
DNB, MNAMS, FIAOG, MICOG, MRCOG
Assistant Professor, Dept. of
G&O
Medical College, Kolkata
Managing Committee Member,
The Bengal Obstetric &
Gynaecological Society
Secretary, Website & Bulletin
Subcommittee, BOGS
Life Member, Indian Association
of Gynaecological Endoscopists
Visiting Consultant & Minimally
Invasive Surgeon
9. DR ABHINIBESH CHATTERJEE
MBBS, DGO, DNB, FRCOG(UK),
Diploma in Gyn Lap (Germany), FMAS
• Consultantat Columbia Asia Hospital, Kolkata
• Trainedin India,UK and Germany in advanced
gynaecological endoscopicsurgery
• Member of AAGL (USA)
• Chairman of Endoscopy Committee of BOGS
• Limca record holder for removing maximum fibroids from
single uterus
• Conducted many Hystero-Laparoscopic workshops and has
helped in many state and national level live workshops and
conferences.
• Has presented and published many papers and also is
author of two books and contributed chaptersin
international books as well.
• Presentation at FIGO in 2012 &2015
• Video presentation at RCOG world congress at Birmingham in
2017 and London in2019
10.
11. Case Scenario 1
• Mrs AC, 33-yr-old
woman having regular
cycles
• Trying for pregnancy for
3 years
• c/o severe and
progressively increasing
dysmenorrhoea and
dysparaeunia
• TVS-
12. Line of management?
• Laparoscopy
• IVF, embryo freezing
and then consider
laparoscopy
• IVF only
• Hormonal therapy for 3
months, then reevaluate
Dienogest
GnRH agonists
13. Factors to decide the mode of
treatment?
• Ovarian reserve- Age,
AMH, AFC
• Semen parameters
• Tubal patency
• Severity of symptoms
• Past surgery
• Previous fertility
treatment
• Patient’s wishes
Mrs AC
Age 33, AMH- 2.5 ng/ml,
AFC- 8+10
Normozoospermia
Tubes not yet checked
Pain not responded to
NSAID
No previous surgery
Received 6 cycles of
letrozole for OI
Relief of pain and wants to
conceive
14. Endometriosis and Subfertility
Hormonal Suppression
• Clinicians should NOT
prescribe ovarian
suppression treatment to
improve fertility
• Most of the hormone
therapies will prevent
pregnancy
• Ovarian suppression does
NOT improve subsequent
ovarian response (ESHRE,
2022)
Surgery
• Still controversial if
cumulative pregnancy rate is
more after surgery but time
to achieve pregnancy was
significantly shorter (ESHRE,
2022)
15. Surgery for Endometriosis-
Subfertility
rASRM stage I/II
endometriosis
Operative laparoscopy could be offered
Improves the rate of ongoing pregnancy
Endometrioma Operative laparoscopy may increase their
chance of natural pregnancy
No data from comparative studies exist
Possible decline in ovarian reserve
Deep
endometriosis
No compelling evidence exists
Operative laparoscopy may represent a treatment
option in symptomatic patients wishing to conceive
(RCOG, 2017; NICE, 2017; ESHRE, 2022)
17. Before surgery
Planned procedure
• Cystectomy/ Drainage
• Adhesiolysis
• Tubal patency
Other investigations
• Do not systematically request
second-level diagnostic
investigations in women with
known or suspected non-
subocclusive colorectal
endometriosis or with
symptoms responding to
medical treatment (ETIC, 2019)
Counselling and consent
• Laparotomy
• Oophorectomy
• Additional procedure
• Unexpected pathology-
hydrosalpinx
• Recurrence
18. During surgery
• Energy sources
• Minimizing ovarian damage
• Ovarian reconstruction
• Anti-adhesion barrier
19. After laparoscopy- Attempt of
natural conception or IVF?
• To identify patients that
may benefit from ART
after surgery, the
Endometriosis Fertility
Index (EFI) should be
used as it is validated,
reproducible and cost-
effective.
• The results of other
fertility investigations
such as their partner’s
sperm analysis should be
taken into account (ESHRE,
2022)
22. Post-operative treatment plan?
• Counselling?
• Ovarian suppression
after surgery?
Chance of recurrence
Better not to delay
pregnancy
Women seeking pregnancy
should NOT be prescribed
postoperative hormone
suppression with the sole
purpose to enhance future
pregnancy rates (ESHRE, 2022)
23. Mrs AC is now pain-free
• Visited 4 doctors over the period of next 2
years.
• Received different brands of letrozole for
ovulation induction- total 12 cycles
• She returns after 2 years
• Now (age 35), she wants IVF
24. Mrs AC
AMH 0.9 ng/ml, AFC 4+3
• In endometriosis, with
and without a history of
ovarian surgery, ovarian
reserve markers were
worse (lower AMH and
higher FSH) compared to
women with male factors
Romanski PA, Brady PC, Farland LV, Thomas AM, Hornstein MD. The effect of
endometriosis on the antimüllerian hormone level in the infertile population. J
Assist Reprod Genet. 2019 Jun;36(6):1179-1184.
25. Endometrioma-related reduction in
ovarian reserve (ERROR)
Kasapoglu I, Ata B, Uyaniklar O, Seyhan A, Orhan A, Yildiz Oguz S, Uncu G.
Endometrioma-related reduction in ovarian reserve (ERROR): a prospective longitudinal
study. Fertil Steril. 2018 Jul 1;110(1):122-127.
26. Endometriosis- surgery or not
Yılmaz Hanege B, Güler Çekıç S, Ata B. Endometrioma and ovarian reserve: effects of
endometriomata per se and its surgical treatment on the ovarian reserve. Facts Views
Vis Obgyn. 2019 Jun;11(2):151-157.
27. Scan finding of Mrs AC
• TVS- B/L
endometrioma
(6 cm in right side, 4
cm left side)
Anything else to note in
the scan
• Accessibility of the
follicles
Next plan?
1. IVF directly?
2. Laparoscopy before
IVF?
28. Surgery before IVF?
In infertile women with
endometrioma > 3 cm only
consider cystectomy prior to
ART to improve
1. endometriosis-associated
pain or
2. the accessibility of
follicles (ESHRE, 2022)
Concern about
endometrioma puncture
during OPU?
• In women with
endometrioma, clinicians
may use antibiotic
prophylaxis at the time of
oocyte retrieval, although
the risk of ovarian abscess
following follicle
aspiration is low (0-1.9%)
(ESHRE, 2022, RCOG 2017)
29. RCOG Scientific Impact Paper (2017)
Directly ART
• Asymptomatic women,
• women of advanced
reproductive age,
• those with reduced
ovarian reserve,
• B/L endometriomas,
• a history of prior ovarian
surgery
Surgery before IVF
• Highly symptomatic
women,
• with an intact ovarian
reserve,
• unilateral and large cysts,
• cysts with suspicious
radiological and clinical
features.
29
30.
31. Case 2
• Mrs PM, 27
years
• Trying for
pregnancy for 2
years
• Cycles regular,
no pelvic pain
• AMH 2.8 ng/ml
• Semen- normal
32. Options for Mrs PM?
• Laparoscopy?
• IVF?
• Noninvasive options?
Implication of ART bill
Repeat HSG
Sonosalpingography
(SSG)
Hysterosalpingo-Contrast-
Sonography (HyCoSy)
33. Precautions before interpreting HSG
• Spasm of the smooth muscles of the tube → “false”
impression of “fallopian tube block” (Suresh and Narvekar,
2014)
• In 40-60% cases of B/L proximal block diagnosed in
HSG, at least one tube may be found open on further
investigations (repeat HSG, SSG, laparoscopy)
(Hajishafiha et al., 2009; Verhoeve et al., 2010; Foroozanfard and Sadat, 2013)
34. Noninvasive options
Repeat
HSG
• After premedication with antispasmodics
• 60% cases initially “blocked” tubes were found open
(Dessole et al., 2000)
• Increased risk of radiation exposure and hypothyroidism
(Hart et al., 2009)
SSG • Relatively simple procedure, no radiation exposure (Suresh
and Naverkar, 2014, Maheux-Lacroix, 2014)
• Assesses uterine cavity, myometrium and the ovaries
• In 70-80% at least one tube is found open by SSG
(Hajishafiha, 2009; Lanzani, 2009)
• Can avoid both laparoscopy and IVF
HyCoSy • Delineates exact site of block (Luciano, 2011)
• Expensive, not easily available
• Meta-analysis-HyCoSy NOT superior to SSG (Maheux-
Lacroix, 2014)
35. Decisive factors for IVF vs
laparoscopy?
• Age of the woman
• Ovarian reserve
• Sperm parameters
• Number of children desired
• Site and extent of the tubal disease
• Risk of ectopic pregnancy
• Risk of OHSS
• Success rates of IVF programme
• Cost- Financial burden- “two
consecutive medical procedures to
achieve parenthood”
• Expertise of the surgeon
• Patient’s preferences
(Suresh and Narvekar, 2014; ASRM, 2015)
SSG of Mrs PM - no spill in POD
36. Laparoscopy- as the “Gold
standard” test for tubal patency?
• Diagnostic error still can happen in
laparoscopy (Broeze et al., 2010; Saunders et al., 2011; Luca et al.,
2017; ASRM, 2015
• No evidence supporting the concept- “Gold
standard” (Tan et al., 2018; Saunders et al., 2011; Lim et al., 2011;
Suresh and Narvekar, 2014)
38. Before surgery
Planned procedure
• Dye test alone
• Additional procedure
Consent
• Consent for additional
unexpected pathology-
ovarian cyst,
hydrosalpinx, adhesion?
39. If the obstruction is not overcome
with gentle pressure
• True anatomic occlusion
is assumed and the
procedure is terminated
• Causes of failed tubal
cannulation (in 93%
cases)
1. SIN
2. chronic salpingitis
3. obliterative fibrosis
4. Tuberculosis Letterie
and Sakas, 1991
• Option 1- IVF
• Option 2- Microsurgical
resection and anastomosis
40. Hysteroscopic Tubal Cannulation
Type of study Authors Successful
cannulation
Concepti
on rates
Ectopic
pregnancy
Case series Ikechebelu et
al., 2018
90.2% per tube and
88.9% per patient
33.3% Nil
Case series Chung et al.,
2018
67.0% per tube and
71.4% per woman
55% No data
Cohort study Mekaru et al.,
2011
25.9% per tube and
37.1% per patient
30.77% 7.69%
Meta-analysis Honore et al.,
1999
85% per tube tube 48.9% 9.2%
• Proximal tubal obstruction
• Young women
• No other significant infertility factors (NICE, 2013; ASRM, 2015)
41. Mrs PM returns after 3 yrs, still
could not conceive
Explanation?
• Tubal patency ≠ normal function of the tube
(Approbato et al., 2020; Tan et al., 2018; Luca et al., 2017)
• All possible explanations for “unexplained
subfertility”
42.
43. Case Scenario 3
• Mrs BG, 33 yr old
• Trying for pregnancy for only 3 years
• Already received several cycles of OI with CC,
letrozole and hMG
• Semen, AMH, HSG- all investigations done
and all are normal
45. Unexplained subfertility
IUI
• Bypasses cervical factors
• Deposits good number of
motile spermatozoa near the
tubes
• Overcomes “improper”
coital techniques
• “Superovulation” leads to
release of >1 egg and
improves the follicular
development
IVF
• Evaluation of oocyte quality
• Evaluation of embryo
quality
• Bypasses subtle tubal
dysfunction
• IVF Itself can be diagnostic
(Nandi and Homburg, 2016).
46. Treatment as per age and duration
of infertility
(Nandi and Homburg, 2016)
48. • Meta-Analysis
• Success rate of IVF - ∼25% (NNT- 4)
Jacobson et al., 2010 Duffy et al., 2014
OR for ongoing pregnancy (95% CI) 1.64 (1.05– 2.57) 1.94 (1.20–3.16)
The number of infertile women that
should undergo destruction of
superficial peritoneal endometriosis
12 8
The prevalence of grade I/ II
endometriosis among women with
unexplained infertility
≤50%
NNT 24 16
52. Undiagnosed B/L hydrosalpinx
• Perform B/L
salpingectomy taking
consent from the
husband
• Leave it as it is- for
second time surgery
• In an emergency even
where a patient lacks
capacity to consent→
act in the best interests
of the patient, although
the treatment given
must be limited to that
which is a necessity in
the best interests of the
patient (RCOG Clinical
Governance Advice, 2015)
53.
54. Bilateral hydrosalpinx
• After B/L salpingectomy, the women will be
rendered totally dependent on IVF for conception
(Suresh and Narvekar, 2014).
• Paucity of data on long term psychological and
fertility outcomes (Suresh and Narvekar, 2014; Fritz and
Speroff, 2011).
• “Interval salpingectomy”- If refuses surgery prior
to the first IVF, offer surgery if the first cycle IVF
fails (Suresh and Narvekar, 2013).
• “Interval salpingectomy” - cumulative live birth
rates were similar between after 3 cycles of IVF
(Strandell et al., 2001).
55. Surgical aspects of hydrosalpinx
management
• Techniques
• Energy sources
• Complications
56. Alternative to salpingectomy
Laparoscopic salpingectomy is
the “standard”
1. reduces the risk of
2. improves the associated pain
(Suresh and Narvekar, 2013;
Strandell, 2018).
1. Laparoscopic tubal occlusion
2. Laparoscopic salpingostomy
3. Hysteroscopic proximal tubal
occlusion (Suresh and Narvekar,
2013).
• Need large RCT - should be
reserved for complex surgical
cases (Suresh and Narvekar, 2013;
Bhandari et al., 2018)
• If surgery is absolutely
contraindicated, ultrasound-
guided aspiration of
hydrosalpinx at the time of
oocyte retrieval → Increased risk
of recurrence (Suresh and Narvekar,
2013; Strandell, 2018).
Reconstructive tubal surgery-
if >50% retention of normal tubal
mucosa (Suresh and Narvekar, 201;
Strandell, 2018).
1. Limited success for natural
conception
2. Risk of ectopic pregnancy (Suresh
and Narvekar, 2014; Fritz and Speroff,
2011).
57. Salpingectomy in hydrosalpinx
• 2-fold improvement in
implantation rate, pregnancy
rate and live birth rate
1. RCT (Strandell et al., 2001)
2. Cochrane (Johnson et al., 2010)
3. Guideline (NICE, 2013).
• Can theoretically affect the
ovarian reserve and ovarian
response to gonadotropin
stimulation (Suresh and
Narvekar, 2014; Fritz and Speroff,
2011; Strandell, 2018).
• Evidence- similar ovarian
response between treated
and non-treated sides (Surrey
and Schoolcraft, 2001; Kamal,
2013; Strandell et al., 2001; Kotlyar
et al., 2017; Mohamed et al., 2017;
Zhang et al., 2015; Noventa et al.,
2016).
60. Indications of LOD
• PCOS resistant to oral ovulogens
• LH >10 IU/L
• BMI <30 kg/m2
• Needing laparoscopic assessment of the pelvis
• Live too far away from the hospital for the intensive
monitoring required during gonadotropin therapy
(ESHRE, 2018; NICE, 2013; Mitra et al., 2015; Fritz and Speroff, 2011)
61. LOD
• Post-op spontaneous
ovulation rate 40-90% and
50% of them conceive
• Less incidence of multiple
pregnancy and OHSS
• Does not require extensive
monitoring (ESHRE, 2018; Mitra
et al., 2015; Fritz and Speroff, 2011).
• Risk of adhesion
formation → worsens
infertility
• Risk of POF (Lepine et al.,
2017; ESHRE, 2018).
62. • LOD with and without medical ovulation induction may decrease
the live birth rate in women with anovulatory PCOS and CC
resistance compared with medical ovulation induction alone.
• Low-quality evidence suggests that there may be little or no
difference between the treatments for the likelihood of a clinical
pregnancy
• There is uncertainty about the effect of LOD compared with
ovulation induction alone on miscarriage.
• Moderate-quality evidence shows that LOD probably reduces the
number of multiple pregnancy.
• LOD may result in less OHSS.
• The quality of evidence is insufficient to justify a conclusion on live
birth, clinical pregnancy or miscarriage rate for the analysis of
unilateral LOD versus bilateral LOD.