This document discusses various factors that can optimize ART (assisted reproductive technology) outcomes. It addresses:
1) Patient selection criteria like age, BMI, lifestyle factors, medical and reproductive history that can impact success rates.
2) Techniques like using biomarkers to personalize ovarian stimulation protocols, recombinant hormones, antagonist protocols, and LH supplementation that can improve yield and outcomes.
3) Laboratory best practices for media, vitrification, embryo selection through PGS/morphological grading, and single embryo transfer that can maximize success while minimizing risks.
The document provides evidence-based guidance on optimizing each step of the ART process from patient screening to embryo transfer.
Predictive Factors influencing pregnancy rate after intrauterine inseminationDrRokeyaBegum
Intrauterine insemination (IUI) is an assisted reproduction procedure that involves the deposition of a processed semen sample in the upper uterine cavity.This is non invasive and cost effective first line therapy for infertile couple.IUI can be done easily in simple setups.
Challenges - In management of infertilityDrRokeyaBegum
Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive.
Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.
Predictive Factors influencing pregnancy rate after intrauterine inseminationDrRokeyaBegum
Intrauterine insemination (IUI) is an assisted reproduction procedure that involves the deposition of a processed semen sample in the upper uterine cavity.This is non invasive and cost effective first line therapy for infertile couple.IUI can be done easily in simple setups.
Challenges - In management of infertilityDrRokeyaBegum
Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive.
Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.
In Vitro Fertilization (IVF) ovarian stimulation protocols - Assisted reprodu...Anu Test Tube Baby Centre
Presentation given in 2016 on protocols used for ovarian stimulation when undertaking in vitro fertilization (IVF) for management of infertility when using assisted reproductive technologies.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
The loss of pregnancy at any stage - devastating experience, both patient and physician.
Recurrent miscarriage is defined as the occurrence of three or more consecutive spontaneous abortion before 20wks of gestation.
Ectopic, molar and biochemical pregnancies not included.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Optimization of ovarian stimulation to improve success rate in ‘ART’Apollo Hospitals
ART is defined as the technique used where there is a need for in-vitro preparation or manipulation of gametes. The commonest ARTs are intrauterine insemination (IUI) and in-vitro fertilization (IVF). Ovarian stimulation is required with these procedures to increase the pregnancy rate as ART with natural cycle has a very low pregnancy rate. Optimizing pregnancy rates per cycle is the real basis for ovarian stimulation protocols in ART.
In Vitro Fertilization (IVF) ovarian stimulation protocols - Assisted reprodu...Anu Test Tube Baby Centre
Presentation given in 2016 on protocols used for ovarian stimulation when undertaking in vitro fertilization (IVF) for management of infertility when using assisted reproductive technologies.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
The loss of pregnancy at any stage - devastating experience, both patient and physician.
Recurrent miscarriage is defined as the occurrence of three or more consecutive spontaneous abortion before 20wks of gestation.
Ectopic, molar and biochemical pregnancies not included.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Optimization of ovarian stimulation to improve success rate in ‘ART’Apollo Hospitals
ART is defined as the technique used where there is a need for in-vitro preparation or manipulation of gametes. The commonest ARTs are intrauterine insemination (IUI) and in-vitro fertilization (IVF). Ovarian stimulation is required with these procedures to increase the pregnancy rate as ART with natural cycle has a very low pregnancy rate. Optimizing pregnancy rates per cycle is the real basis for ovarian stimulation protocols in ART.
Mark Perloe, MD Atlanta, 404-843-2229 Learn about the factors that can adversely affect fertility and the tests that can help pinpoint problems. Fertility treatment options including IVF and other high tech options are presented.
medical management of infertility,think before surgery!!!!ShitalSavaliya1
Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
Postpartum haemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth.
It affects about 5% of all women giving birth around the world.
Globally, nearly one quarter of all maternal deaths are associated with PPH. In most low-income countries, it is the main cause of maternal mortality.
Pruritus affects upto 20% of pregnant women.
There are conditions unique to pregnancy that involve pruritus as a leading symptom.
This is called dermotoses of pregnancy.
May produce risk to mother and foetus.
Approach to skin lesions in pregnancy: Pruritus related to pregnancy, Pruritus not related to pregnancy
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
4. Fertility is decreased by half in woman in their late 30s
compared with woman in their early 20s.
IVF cannot reverse the effect of age on fertility .
Age
Live birth rate following IVF diminish by
2% for each year of female age.
5. Maternal age is a strong
independent factor for
increase in outcome of
IVF.
6. Decline in male fertility
Increase risk of genetic mutation
Autism related disorder after age of
45-50 years.
Advanced
Paternal Age
7. Life style
Weight
Obesity
-BMI 30kg/m2
under weight
-BMI 18kg/m2
Both obesity and under
weight are associated with
decline fertility through chronic
anovulation.
Why
Reduced responsiveness to
stimulation protocol.
Higher cycle cancellation rate.
Embyo quality.
Impaired embyo implantation
rate.
Particularly abdominal adiposity.
8. Pregnancy rate decreases by
30% per cycle for each 0.1
increase in waist/hip ratio.
In men obesity
• Abnormal sperm count.>35kg/m2
• Higher DNA fragmentation.
9. Pathogenic mechanisms
- Increase testicular temp due to fat deposition.
- Decrease in circulatory testosterone due to sleep apnea.
- Hyper insulinaemia.
- Dysregulation of HPO by increased oestrogen.
11. Alcohol
All woman should be assessed for alcohol use and
advised of the risks to fertility and to the fetus. Woman
should be informed that there is no safe level of
alcohol exposure in pregnancy.
Alcohol Causes :
- Anovulation
- Impaired implantation
- Reduced libido
- Impotency
- Abnormal sperm parameter
12. Psychosocial
stress
In Women -
1. Lower number of oocyte retrieval
2. Lower implantation
3. Lower pregnancy rate
In Men –
Stress - testosterone
spermatogenesis
13. Immunization
The assessment of the woman’s vaccinations
history is strongest recommended before
beginning the treatment of infertility.
14. Autosomal recessive disease –
carriers are asymptomatic.
Thalassemia
- use of donor gametes
- pre implantation genetic diagnosis
Genetic counseling
15. Adverse outcomes in previous pregnancies –
1. Counsel regarding recurrence of another event .
2. Preventive strategies –
Repeat miscarriages, still birth or preterm
delivery necessitate work up to identifies the
cause.
Reproduction history
16. Chronic medical conditions
Maternal fetal medicine specialized involved
to care these woman in pre conceptional
stage.
For majority of chronic disease optimal
control prior to ART for favorable maternal
and neonatal outcome.
17. High risk for pregnancy
pulmonary HTN
Eisenmenger’s syndrome
Marfans syndrome, with aortic involvement.
Severe renal insufficiently.
19. Men are active
partners in ART
Undergo medical evaluation
before ART in order to detect
and modify high risk
behaviors and poorly
controlled diseases.
22. 1.Submucous fibroid is essential to remove before IVF.
2. Sub serious fibroid should be ignored.
3. There are no studies to confirm the value of
removing intramural fibroids.
However there is evidence to suggest a benefit after
removing them.
Treatment
Fibroid
23. Hydrosalpinx which are visualized by
USG reduced IVF outcome and should be
removed.
As an alternative cornual ligation could
be done.
Hydrosalpinx
24. Surgical management of endometriomas has no
significant effect on IVF pregnancy rates and
ovarian response to stimulation.
Endometrioma
Fewer oocytes were retrieved.
Endometrioma effect oocyte number
but not embryo quality or pregnancy
outcome, irrespective of the presence of
an ovarian endometrioma.
26. Sharam et al (1997) recommended that all
couples with elevated titers of chlamedia
trachomatis IgG antibodies be treated with
Doxycycline prior to IVF.
Pelvic infection before IVF
27. IVF patient with bacterial
vaginosis have decreased
conception rates and increased rate
of early pregnancy loss.
28. Ovarian stimulation
There is a strong association between
the number of oocytes retrieved and
live birth rates in IVF.
29. The optimum number of oocytes needed to
maximize IVF outcomes seems to be about 15.
COS should be tailored to individualized.
Maximum – for poor responder
Fine tuning for – Hyper responder
30. Young and older patients
Polycystic ovaries/PCOS
High basal FSH/small ovaries
Previous OHSS/poor response
Easily
Recognized
Who is Who in ART
31. AMH and AFC are currently
the best tools to predict ovarian
response .
BIOMARKERS of
Ovarian Response
34. Rec hFSH has greater
potency compared to
both HMG and HP
HMG.
35. Protein
content
Specific activity
(IU/mg protein)
Injected
protein per
75 IU (mcg)
hMG < 5% ~100 ~750
hMG-HP < 70% 2,000–2,500 ~33
rec-hFSH* > 99% 13,645 6.1
Size Exclusion
High
Performance
Liquid
Chromatograph
y (SE- HPLC)
Protein content in solution
bymass (FbM)
37. Accurate dose delivery
Adjustments by small
increments Self-administration
25%
Folitropin alfa prefilled
ready-to- use
pen
Needle-free
reconstitution,
conventional syringe
Easy of use 58%
Dosing mechanism 43%
Less chance of error 26%
75%
41. Intervention Outcome Evidence
Ovarian biomarkers Identify who are at risk 1a
Recombinant rather than urinary
gonadotropins
Oocyte yield 1a
Biomarkers + low starting doses of rec-
hFSH FbM
Fine-tune COS + oocyte
yield
1b
GnRH Antagonists OHSS 1a
GnRH Agonist for LH Triggering OHSS 1a
Two-step IVF OHSS 1b
Evidence-based Strategies to Optimize
COS in High Responders
45. Culture media
Sequential – where embryos are
moved part way through the
culture period to a medium with a
different composition.
Single step – Embryo are held in
the same dish throughout and
culture medium is not
replenished any point.
46. Single step media – is advantageous
when used in conjunction with
continuous embryo monitoring
system.
This minimizes –
stress to embryo
change in PH
Light
Temp outside the incubator
51. 1. Avoid the formation of ice crystals during the
freezing process.
2. Intracelluler crystal formations creates lethal
factors through unwanted physical and chemical
events that may injure the cell during the
cryopreservation process.
The most important principle of
cryopreserving oocytes and embryos
52. 1. No mechanical injury
2. Less osmotic stress to cells.
3. No intracellular crystal formation.
4. Less labor in laboratory daily work.
5. Simple protocol.
6. Useful for oocytes and blastocyst which have less
success with slow freezing.
7. No need for expensive devices.
Why do to prefer the Vitrification
procedure now ?
53. Fresh embryo transfers can be
replaced by cryopreserved – thawed
embryo transfers in ART cycles.
COH has been shown to
advance endometrial
maturation and adversely
affects implantation in
ART.
There is a better embryo-
endometrium synchrony in
frozen-Thawed embryo
transfer cycles than fresh
embryo transfer cycles.
54. Freeze all cycle – safer approach to
eliminate risk of hyper stimulation
with at least equivalent results and
better obstetric and perinatal
outcome versus fresh embryo prefer.
55. Embryo grading has been proposed
as the most appropriate system for
selecting the best embryo.
Assessment of morphological
characteristics is an easy and non
invasive way.
Selection of embryo
56. Preimplantation genetic screening (PGS).
Age more than 40 yrs -
- Risk of trisomy
- Risk of miscarriage
RIF (Repeated Implantation Failure).
Recurrent Miscarriage
Male Infertility
Technique to assess embryo
quality
57. PROS
- Time to pregnancy decrease
- Decreased risk of miscarriage
CONS
- More RCTs required
- Embryo may be autocorrect
- Mosaicsm : confusing the issue
of transfer
58. No of embryo transfer
Single embryo transfer
VS
Multiple embryo.
59. Faced with the prospect of never giving birth, women
were willing to accept a significantly greater risk of
experiencing the worst perinatal outcome.
Perinatal death was valued significantly lower than
treatment failure (P values < 0.001) .
All disability outcome were valued significantly higher
than the no birth outcome (all P values < 0.001).
60. Techniques and technology for
Embryo transfer
Parameters affecting ET outcomes
1. Anatomy
- Uterine position
- Utero cervical angle
- Bacterial inoculation
- Uterine contraction
2.Technique
- catheter guidance
- catheter tip location
- injection mode
61. 3. Catheter
- Soft versus firm
- Internal diameter
- Tip shape
4.Transfer medium
- Medium/Air volume
- Viscosity
- Adherence compounds
62. ET practices with supported
proof benefit
Use of soft embryo catheters
Ultrasound guidance
63. 1. Mid uterine position of catheter tip.
2. Mechanical closure of the cervical canal following ET.
3. Acupuncture during ET
4. Use of hyaluronic acid during ET
5. Shortening of the loading discharging interval time of embryos.
ET practices with Limited proof
benefit
64. 1. Use of mock transfer.
2. Full bladder during ET.
3. Use of cervical tenaculum.
4. Removal or flushing of cervical mucus.
5. Antibiotic administration during ET.
6 .Bed rest following ET.
7 Use of fibrin sealants during ET.
ET practices with no proof
benefit
66. Strategies for improving endometrial
receptivity
To develop ovarian stimulation protocols-
minimal reduction of receptivity or increase it.
To avoid the endometrium during stimulated
cycle- Freezing the embryo and replacing in
subsequent natural cycles.
To increase uterine vascularity- Low dose
aspirin, L-arginine, Sildenafil.
To treat the uterine pathology.
5.Local injury stimulates the endometrium.
67. Luteal phase support
Corpus luteum
A major source of steroid
hormone and secretes
progesterone upto 40mg/day. LPS is definitely
indicated in IVF
treatment cycle.
68. When to start progesterone
Day of OPU
How long
Debatable
1. Upto 8weeks or 12 weeks
2. Upto 1st ultrasound scan
3.Upto establishing pregnancy
69. What is the route
1.Oral-micronised 600-800mg/day in a divided dose.
2.Vaginal/ Rectal- micronised 600-800mg/day in a
divided dose.
3. I/M 50-100mg/day
4. S/C Aqueous 25mg/day
5. Dydrogesterone-10mg twice daily
6. Gel 8%-90 mg once daily
70. No evidence favoring a
specific route or duration of
administration of progesterone.