This document summarizes new directions in in vitro fertilization (IVF) being explored at FertilitySA to address common problems experienced by couples. These include using growth hormone to increase egg yield for those with low ovarian reserve, selecting sperm for ICSI based on hyaluron receptors, preimplantation genetic testing to identify genetic problems, endometrial biopsies to improve implantation, and culturing embryos in media containing GM-CSF to help with recurrent miscarriage. Ongoing trials are exploring the use of corifollitropin alfa to reduce injections and improve outcomes. The overall aim is to continue improving treatment through research and providing individualized care.
IVF and getting pregnant are very complex procedures and the combination of both sometimes seems to be an impossible task.
So there are many additional treatments used to improve implantation and pregnancy rates. Which are really helpful and which just helps the doctor earn somme money?
Here you find a short overview, bus certainly not all the answers to the questions above.
Higher Number of Embryos
Blastocyst culture
PID
IMSI
Hatching
Acupuncture
ASS
Heparin
How to prevent occurrence of severe ovarian hyperstimulation in IVF. Is there a way ? this talk will present a pilot randomised study that may shed the light on this
IVF and getting pregnant are very complex procedures and the combination of both sometimes seems to be an impossible task.
So there are many additional treatments used to improve implantation and pregnancy rates. Which are really helpful and which just helps the doctor earn somme money?
Here you find a short overview, bus certainly not all the answers to the questions above.
Higher Number of Embryos
Blastocyst culture
PID
IMSI
Hatching
Acupuncture
ASS
Heparin
How to prevent occurrence of severe ovarian hyperstimulation in IVF. Is there a way ? this talk will present a pilot randomised study that may shed the light on this
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
platelet rich plasma is being used in infertility management extensively without sound evidence of its value. In this talk, we will discuss the real impact of using PRP in IVF
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
Free Information Session "10 Tips for Healthy Conception"Fertility SA
Dr Jodie Semmler spoke about the top ten tips our Fertility Specialists recommend to boost your chances of conception. Dr Semmler is one of Adelaide's leading gynaecological surgeons. She has had extensive experience in laparoscopic keyhole surgery treating fertility issues including the excision of endometriosis. Dr Semmler is also a sitting member of the Australian IVF Directors group.
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
platelet rich plasma is being used in infertility management extensively without sound evidence of its value. In this talk, we will discuss the real impact of using PRP in IVF
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
Free Information Session "10 Tips for Healthy Conception"Fertility SA
Dr Jodie Semmler spoke about the top ten tips our Fertility Specialists recommend to boost your chances of conception. Dr Semmler is one of Adelaide's leading gynaecological surgeons. She has had extensive experience in laparoscopic keyhole surgery treating fertility issues including the excision of endometriosis. Dr Semmler is also a sitting member of the Australian IVF Directors group.
Free Information Session 8th May 2013: Endometriosis and Infertility - Treatm...Fertility SA
Dr Jodie Semmler presented about the treatment options available for sufferers of Endometriosis. She outlined what they entail and how fertility treatment is individualised to provide the best possible outcomes.
Dr Semmler is one of Adelaide's leading gynaecological surgeons. She has had extensive experience in laparoscopic keyhole surgery treating fertility issues including the excision of endometriosis. Dr Semmler is also a sitting member of the Australian IVF Directors group. For more information on Dr Semmler, please follow this link http://www.fertilitysa.com.au/dr-jodie-semmler-specialist.html
Ovarian reserve testing is important before planning IVF cycle, ovulation induction, family planning reasons, before and after chemotherapy and radiotherapy. Ovarian reserve testing such as AMH may help also in diagnosis of granulosa cell tumors and amenorrhea.
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
In this presentation during 4th National Conference Embriology ISAR, we discussed about the oocyte inefficiency faced by women, evaluated if there is any solution to overcome this problem, and finally suggested an alternative. All of this presenting evidence that the ovarian stimulation is not related to a decrease in embryo quality. Maximizing the number of oocytes retrieved during ovarian stimulation, is the best way to improve the cumulative live birth rates per ovarian stimulation, decreasing the number of ovarian stimulation and oocyte pick-ups necessary to achieve the mainly goal of an IVF treatment: a health live birth
Indivisualization of Ovulation Induction - Dr Dhorepatil BharatiBharati Dhorepatil
IVF started to develop fast with the aim of maximizing pregnancy rates per cycle
Higher number of oocytes and thus more embryos
Use of unphysiological high doses of gonadotropins
Time consuming protocols
Higher costs
Patient discomfort
Higher risk of OHSS
Very high risk of multiple gestation
Role of Atosiban In ART,Dr Jyoti Agarwal, Dr. Sharda Jain Lifecare Centre
Exponential increase in IVF Procedures in India
India performs approx 1 Lac IVF cycles annually &
55% of the IVF cycles performed across the top eight metro cities
Miscarriage is pregnancy loss before 22 weeks’ gestation based on the LMP or if gestation age is unknown, it is the loss of an embryo or a fetus of less than 500g.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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
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
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.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
4. Why don’t couples conceive with IVF?
They have problems:
We understand but can’t fix We don’t understand well
Low ovarian reserve Implantation problems
Poor sperm quality Miscarriage
Genetic problems High levels of stress
Improve selection Test new ideas
12. Does Growth hormone work?
• We’re not sure:
• Growth Hormone made no difference for all
women undertaking IVF
• In women with low ovarian reserve there
was a trend to improved outcomes.
13. The Light Study (74 recruits)
Women under 41 with low ovarian reserve
Randomised trial to see if Growth hormone:
1.increases the numbers of eggs
2.Improves pregnancy outcomes
At FertilitySA
50% pregnancy rate on the trial
But we don’t know who had growth hormone
19. At FertilitySA
More than 20 PICSI pregnancies last 7 months
–first approx 30 weeks gestation now
Clear benefit in fertilisation and embryo development
for some couples
No benefit :
very poor samples
very good samples
Surgical sperm
22. Fluorescent In Situ Hybridisation
Small number of
Y 21 chromosomes tested
21
Subjectively assessed by
21
X embryologist looking down
the microscope
Down’s Syndrome
But:
Studies showed increased chance of livebirth if didn’t use test
23. Array Prenatal Diagnosis
24 sure = Blue Gnome = CGH arrays
Technological improvements:
All chromosomes checked
Several probes for each chromosome
Results objectively read by machine
24. Are the outcomes better?
Initial studies are very promising but large studies
over time not done.
Melbourne IVF has the most experience in Australia
FertilitySA
Small numbers of cycles and good results
Performing the biopsy in our lab
Sending the cells to Melbourne IVF for Array testing
Replacing genetically competent embryos in Adelaide
28. Why might a biopsy work?
Human cycles with surgical instrumentation of the
uterus have higher pregnancy rates (historical)
Can induce endometrial receptivity in animals by
instrumenting the uterus
29. Does it work?
Cochrane Database Syst Rev. 2012;7: (last week)
Review of all randomised control trials (294 +297
women)
– Higher clinical pregnancy rate and live birth rate
– Benefit when biopsy 1 week prior to an IVF cycle
How does it work?
? Induces a repair process similar to implantation
? Releases factors that help implantation
? Promotes stem cell activity to facilitate implantation
30. At FertilitySA
Perform outpatient biopsy or hysteroscopy and
biopsy in implantation window
Send the tissue to the lab
IVF cycle with following period
Outcomes:
Several patients have become pregnant with good
outcomes
Effect lasts for at least 3 months
33. Embryogen
• IVF media with GMCSF growth factor
• In Adelaide, laboratory and animal studies
showed that culture media with this growth
factor was associated with:
– better embryos
– better pregnancy outcomes
34. Human embryos have GM-CSF
receptor
21
Day 8 embryo Day 5 embryo
Sjolblom et al Biol Reprod 2002
GM-CSF is in fallopian tubes, lining of womb and uterine
fluid
But : IVF culture medias do not contain GM-CSF
35. In human embryos
control GM-CSF
Total dead cells
p<0.001 Robertson et al Biol Reprod 2001
5
6
4
3
2
1
APOPTOSIS Control
GM-CSF
%
Total cell no.
p<0.001
0
0
0
0
0
0
0
0
36. Improved Outcomes for women with a previous
miscarriage in a large European trial
Ongoing Implantation EmbryoGen® Control Diff. P-value
rate mean (%)
Previous miscarriage patients
(327 subjects, 142/147 transfer cycles)
Week 7 24.5 17.0 44.1 0.001
Week 12 23.2 16.5 40.6 0.003
* During the course of the study the concentration of human serum albumin (HSA) was increased in EmbryoGen ® as well as in EmbryoAssist™.
This was done to improve the overall performance and robustness of EmbryoAssist™
36
37. Safety study:
GM-CSF has no effect on embryonic chromosomal constitution
Embryos (%)
Agerholm et al., 2010
38. At FertilitySA
• Embryogen Trial
• FertilitySA is the only unit registered to prescribe
embryogen in South Australia (Only 2 units in
Australia are registered to use Embryogen)
• Inclusion criteria:
• Women with a previous miscarriage under 41 years.
• Couples can buy media outside trial
• Day 3 transfer –growing frozen embryos out to Day 5
39. Results so far:
6 patients have participated in the trial
4 have completed the cycle -2 pregnancies -1 scanned
Outcomes
Good embryo quality
The first embryogen
pregnancy in Australia
had a normal first scan
44. Stimulation protocols have required multiple injections
Long GnRH
1 2 3 4 5 6 7 8 9 10 agonist
protocol
GnRH
Flare-up
1 2 3 4 5 6 7 8 9 10 antagonist
protocol
Pituitary downregulation
LH Direct
gonadotrophin
suppression
Time
Figure adapted from de Greef R et al., 2010,1 The European Orgalutran Study Group, 20002 and Hodgen GD,1990.3
45. Long acting FSH -ELONVA
rFSH hCG
Corifollitropin alfa
1 2 3 4 5 6 7 8 9 10
Before use After use
81% cumulative pregnancy rate in initial trials in good prognosis patients
References: 1. Elonva Product Information, July 2010.
46. The Create Trial
Inclusion Criteria:
Women on an antagonist cycle
<90kg
At low risk of hyperstimulation syndrome
Women in study use either Elonva or traditional injections
Participation:
Answer 2 surveys regarding the ease and stress of IVF cycle
Monitor outcomes during the cycle
47. Research and Education is important
Benefits to our patients
Our doctors stay up to date with the improvements in IVF
Care can be individualised if its well understood
We continually try to improve our treatment for every
couple under our care
Some couples will become pregnant that wouldn’t have
otherwise
Everything we learn will help someone
48. Thank -You
Staff and patients at FertilitySA
Prof Sarah Robertson –University of Adelaide
Dr Michael Henman –Origio
Dr Brett Johnson -MSD
Current treatments for COS are still complex. The long GnRH agonist protocol involves treatment for several weeks before the start of stimulation and requires many injections. There are usually 14 additional injections required in a long GnRH agonist protocol compared with GnRH antagonist protocols. † † Where only injectable formulations are used The GnRH antagonist protocol (developed in the early 2000s) has reduced the impact of COS on patient treatment burden by reducing the required number of injections, but still involves daily gonadotrophin administration for follicular development.
Formulation of non-pf and pf corifollitropin alfa drug product, respectively: Sucrose: 50 vs 70 mg/mL (Puregon 50 mg/mL) Sodium citrate: 14.7 vs 7.35 mg/mL (Puregon 14.7 mg/mL) L-methionine: none vs 0.5 mg/mL (Puregon 0.5 mg/mL) Polysorbate 20: 0.2 mg/mL vs 0.2 mg/mL (Puregon 0.2 mg/mL) The passive safety system means that you do not need to take or perform any additional action when using the device to activate it (at the end of a full stroke / injection).