This document summarizes information about GnRH agonists and antagonists used for pituitary suppression during IVF treatment. It discusses that both drugs are used to suppress LH levels and prevent a premature LH surge, but that GnRH agonists have been used longer with more studies and experience. While meta-analyses have found no significant differences in live birth or pregnancy rates between the two protocols, some studies found advantages of agonists for certain patient groups or outcomes. The document provides details on how each drug works and comparisons of the different protocols.
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
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Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
In ART, GnRH antagonists are effective in preventing a premature LH surge and induce a shorter and more cost-effective ovarian stimulation compared to the long agonist protocol.
What trigger agent can be used when using assisted reproductive technologies when dealing with infertility?
Pros and cos of different techniques and what is used where.
IVF related information
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Individualizing Ovarian Stimulation Protocols for IVFSherInstitute
Have you experienced poor response to IVF medications? Been told you had "Empty Follicle Syndrome?" Had lots of eggs retrieved but very few fertilized? Experienced Ovarian Hyperstimulation Syndrome? All of these issues can be tied to or affected by your protocol of stimulation. Dr. Geoffrey Sher presents his approach to customizing ovarian stimulation based on 30 years' experience in the IVF field. He outlines a number of his stimulation protocols and discusses the factors that can cause IVF failure due to improper stimulation protocols.
In ART, GnRH antagonists are effective in preventing a premature LH surge and induce a shorter and more cost-effective ovarian stimulation compared to the long agonist protocol.
What trigger agent can be used when using assisted reproductive technologies when dealing with infertility?
Pros and cos of different techniques and what is used where.
IVF related information
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Individualizing Ovarian Stimulation Protocols for IVFSherInstitute
Have you experienced poor response to IVF medications? Been told you had "Empty Follicle Syndrome?" Had lots of eggs retrieved but very few fertilized? Experienced Ovarian Hyperstimulation Syndrome? All of these issues can be tied to or affected by your protocol of stimulation. Dr. Geoffrey Sher presents his approach to customizing ovarian stimulation based on 30 years' experience in the IVF field. He outlines a number of his stimulation protocols and discusses the factors that can cause IVF failure due to improper stimulation protocols.
Which type of Gonadotrophins should we use for ovarian stimulation in IVF?Hesham Al-Inany
There are many types of gonadotropins: some are recombinant , others are urinary derived. some contain LH like activity , others do not. which to use?? many research with conflicting results but the final word came from Cochrane mega- systematic review. This talk will illustrate this issue
recurrent miscarriage is a real clinical problem with different aetioogies. However, recent observations pointed to vascular dysfunction as a main underlying factor: how ? this talk may help in illustrating this
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Anu Test Tube Baby Centre
Presentation given in 2017. Management of infertility using assisted reproductive technologies.
What is the role of antagonist in IUI and IVF - tips and tricks to optimize its use.
Study design: A Randomized prospective comparable study.
Objective: To compare the effi cacy of GnRH agonist stop antagonist and GnRH antagonist protocols in ICSI outcome for women
who are expected to have poor ovarian response.
Setting: ART unit of Obstetrics and Gynecology Department of Qena University Hospital, South Valley University, Egypt.
Duration: From September 2016 to December 2017.
Strategies for improving success in Poor respondersKaberi Banerjee
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.
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
Spectroscopy is a branch of science dealing the study of interaction of electromagnetic radiation with matter.
Ultraviolet-visible spectroscopy refers to absorption spectroscopy or reflect spectroscopy in the UV-VIS spectral region.
Ultraviolet-visible spectroscopy is an analytical method that can measure the amount of light received by the analyte.
Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
In this webinar we give an overview of advanced applications of the IVM system in preclinical research. IVIM technology is a provider of all-in-one intravital microscopy systems and solutions optimized for in vivo imaging of live animal models at sub-micron resolution. The system’s unique features and user-friendly software enables researchers to probe fast dynamic biological processes such as immune cell tracking, cell-cell interaction as well as vascularization and tumor metastasis with exceptional detail. This webinar will also give an overview of IVM being utilized in drug development, offering a view into the intricate interaction between drugs/nanoparticles and tissues in vivo and allows for the evaluation of therapeutic intervention in a variety of tissues and organs. This interdisciplinary collaboration continues to drive the advancements of novel therapeutic strategies.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...
GnRH Agonist vs GnRH Antagonist what to choose?
1. ISO 9001 :2008 CERTIFIED CENTER
New hope to
Infertile couples!
1
2. Dr. Ritu S Santwani M.B.B.S, MD, FICOG
IVF -Infertility (Test Tube Baby) Specialist
Director -Pune TestTube Baby Center
Center Address:
Liberty , Phase -2, C-6 , Opp Lane -5
North Main Road, Koregoan Park
Pune – 411001
http://www.punetesttubebabycenter.com
2
PUNE TESTTUBE BABY CENTER
6. THESE ARE TWO DRUGS USED
FOR THE SAME PURPOSE:
LH SUPPRESSION FROM
PITUTARY FOR PREVENTING
ENDOGENOUS LH PEAK SO WE
CAN TIME THE OOCYTE RETRIVAL
6PUNE TESTTUBE BABY CENTER
7. • The first report on use of GnRH agonist (buserelin) +
Gn for ovarian stimulation for IVF was in --- 1984
• Incidence of premature LH surge & subsequent
luteinization with Gn stim without GnRH agonist was
20 – 50 % ,leading to increased cancellation rates &
deleterious effects on fertilization/pregn rates.
7PUNE TESTTUBE BABY CENTER
8. • The receptors (R) after
intracellular synthesis are
randomly inserted into the cell
membrane.
• The R has 3 important
regions :
→ External -- to bind to the
hormone
→ Transmembrane region
→ Internal 8PUNE TESTTUBE BABY CENTER
9. 1. Activated Calmodulin
+
2. Activated PKC
↓
Cause release of
Gonadotophins (FSH & LH)
FLARE UP 4 times FSH and 10
times LH release
9PUNE TESTTUBE BABY CENTER
10. • Over the time b/o over abundance
of agonists with longer half life,
the dimer form of receptors is
favored and the receptors go into
the cell and cannot come back
so
• Cannot respond to subsequent
pulses of GnRH
• Thus the gonadotrops become
desensitised and this is called
down regulation of GnRH
receptors
11. • DESENSITIZATION
• When the GnRH receptors
exposed to GnRH agonists for
a prolonged period, the cells
lose their ability to respond to
the stimulus with their original
sensitivity.
• Process is rapid & reversible.
• Process operates at both the
receptor level & by post
receptor modification
12. Agonist is the ---- Conventional
---- Time tested & trusted
---- More efficacious
---- Many modifications
“ OLD IS GOLD “
12PUNE TESTTUBE BABY CENTER
13. Many treatment schedules with the use of
GnRH agonists in ART have been designed.
It has to be tailored as per the patient profile.
The 2 most widely used GnRH agonist protocol
in COS for ART are :
→ Long Luteal Protocol
→ Short Protocol
13
PUNE TESTTUBE BABY CENTER
16. -- The GnRH agonist is started on Day-21 of
the cycle preceeding tt.
-- GnRH agonist is continued in parallel along
with Gn.
-- Gn started after pituitary downregulation
Some modifications :
→ Long Follicular
→ Early cessation/Stop
→ Long Luteal Mini-dose
16PUNE TESTTUBE BABY CENTER
17. -- They utilize the initial temporary
flare effect of the agonist to
promote follicular recruitment
during menstruation before the
supressive action takes over.
-- More suitable for older patients
or poor responders.
Some modifications :
→ Ultrashort
→ Micro-dose Flare
17PUNE TESTTUBE BABY CENTER
18. The long mid-luteal protocol
has consistently been reported
to be more effective than
short or ultra-short protocols as
far as pregnancy rates are
concerned & the most recent
Cochrane review has confirmed
these.
Disadvantages : Higher cost as
more Gn used
18
PUNE TESTTUBE BABY CENTER
19. Agonists offers many advantages over
Antag..
Agonist long protocol : (Advantages)
1) Stable & low LH & P4 levels
throughout the stimulation phase.
2) Suppression of endogenous FSH
levels leading to a follicular cohort of
all small follicles at the initiation of
FSH stimulation
→in a synchronized follicular
development
19PUNE TESTTUBE BABY CENTER
20. 3) Agonist use is associated with ↑ HOXA 10 expression, so ↑ endometrial receptivity.
(Orvieto et al., 2008a )
4) Significantly higher number of oocytes and higher proportion of mature MII oocytes was
retrieved per patient randomized, in the GnRH agonist group Depalo et al. Reproductive
Biology and Endocrinology 2012
5) So increased chance of pregnancy in current as well as subsequent cycles with cryo-
preserved embryos.
6) Better programming of treatment schedule. Reduces the cycle cancellation rates (2%)
7) Can be used to induce final maturation & ovulation instead of hCG in antagonist protocol
8) Very good protocol for normal responders
20PUNE TESTTUBE BABY CENTER
21. 21
1) Longer pretreatment period required
2) Initial “flare up” of FSH & LH may lead to ovarian cyst formation.
3) Excessive follicle selection leading to higher incidence of OHSS, especially
in PCOS patients.
4) Over suppression in poor responders requiring a higher dose of
Gonadotropins or a poor response.
5) Higher incidence of multiple pregnancy.
6) Luteal phase support is required.
7) Increased total gonadotropins dose per
treatment cycle.
8) Higher cost
9) Daily administration
PUNE TESTTUBE BABY CENTER
22. 1) LH levels remain unsuppressed during the early follicular
phase, so ↑ LH, E2 & P4 as well.This adversely affects
endometrial receptivity, so pregnancy rates too.
2) High intercycle endogenous FSH concentration induces
secondary follicular recruitment, leading to asynchronous
follicular development.
22
PUNE TESTTUBE BABY CENTER
26. • Patients with an unfavorable prognosis (patients with repeated
IVF failure )
GnRH agonist protocol was superior, showing a significantly
higher clinical pregnancy rate, when compared with the
antagonist protocol
(20.8% versus 14.5%; P < 0.02).
Orvieto et al., 2009)
PUNE TESTTUBE BABY CENTER
33. 33
GnRH antagonists versus
agonist protocols in non
obese women with polycystic
ovarian syndrome showed
similar embryological &
clinical efficacy of both
protocol.
Kurzawa et al, J Assist Reprod Genet 2008
PUNE TESTTUBE BABY CENTER
34. 34PUNE TESTTUBE BABY CENTER
No difference between the two
protocols
In terms of quality of oocyte
morphology or oocyte dysmorphism.
Conclusion –
Oocyte dysmorphism was not
influenced by the type of pituitary
suppression.
Cota et al, Reprod Bio Endocrinol 2012
35. 35
Marci et al compared ovarian stimulation in women with high & normal body
mass index (BMI) in both agonist & antagonist protocols.
Patients with BMI >25kg /m2 were found to require a higher amount of
goandotropins in the agonist protocol compared to those with normal BMI.
Conclusion
Obesity could impair the ovarian response to gonadotropins
In patients with normal BMI clinical pregnancy rates were similar with both
protocols
Marci et al, Gynecol Endocrinol 2012
PUNE TESTTUBE BABY CENTER
36. Clear advantage was gained in duration of stimulation with
GnRH-anta in poor ovarian responders undergoing IVF,
although there was no statistical difference in the number of
oocytes retrieved, the number of mature oocytes retrieved,
the CCR and CPR between GnRH-ant and GnRH-a protocols.
Comparisons of GnRH antagonist versus GnRH agonist protocol in
poor ovarian responders undergoing IVF Danhua Pu1,2,jie Wu1,2,*
and Jiayin Liu1,2 Human reproduction 2011
36PUNE TESTTUBE BABY CENTER
37. • A randomized prospective study compared an antagonist protocol with
a long agonist protocol in poor responders and concluded that there
were no significant difference in the cycle cancellation rates, duration of
stimulation, dosage of gonadotropins (a fixed dose was used), and mean
numbers of mature follicles, oocytes, and embryos obtained .
Cheung L-P, P-M, Lok I, Chiu T, Yeung S-Y, Tjer C-C, Haines C.GnRH
antagonist versus long GnRH agonist protocol in poor
respondersundergoing IVF: a randomized controlled trial. Hum Reprod
2005;20:616 –21
• The implantation rates were similar but the pregnancy rate was higher,
though not statistically significant, in the antagonist group.
37PUNE TESTTUBE BABY CENTER
38. 38
Not the preferred protocol
Why???
Down regulation of the hypothalamic pituitary ovarian axis prior
to gonadotrophins leads to over suppression of ovaries & hence
prolongation of follicular phase & increase in the number of
gonadotropins ampoules required for stimulation or poor
response.
PUNE TESTTUBE BABY CENTER
40. 40
No difference between both protocols regards pregnancy
losses.
No difference in major congenital malformations.
Neonatal outcome was also similar
Boerrigter et al, Human Reprod 2002
PUNE TESTTUBE BABY CENTER
44. 44
Various meta analysis have found no significant difference in the
live birth rates between the two protocols.
They concluded that the probability of live birth was not
dependent on the type of protocol used for stimulation
Kolibianakis et al Human Reprod Update 2006,
Tur Kaspe I & Ezcurra 2009
PUNE TESTTUBE BABY CENTER
45. 45
Recent Cochrane review no significant difference between the
two protocols in terms of clinical pregnancy rates (CPR).
(odds ratio 0.86, AI – 95% confidence interval 0.69-1.08)
Al Inany et al, Cochrane data base Syst Rev 2011
PUNE TESTTUBE BABY CENTER