Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
The Management (mainly the treatment aspect) of Female Infertility is described in brief here (as much as the limit of 55 slides permitted me to discuss!). References from:
Berek and Novak's Gynecology 15th editon
Speroff's Clinical Gynecologic Endocrinology and Infertility 8th edition
And of course, Slideshare itself!
Infertility affects as many as 10% of the couples, the causes, investigations and treatment with mention of management of fibroids and endometriosis has been done in the presentation.
Algorithms for Ovulation induction protocols (Assisted reproductive technolog...Anu Test Tube Baby Centre
Algorithms for ovulation Induction during Assisted Reproductive Technologies for treating infertility. Intrauterine Insemination (IUI) and In vitro Fertilization (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
This Case Presenataiton was presented in Central Presentation of Faridpur Medical College Hospital, in November 2019, by Dr. Faisal Abdullah, MBBS; who was an Intern Doctor of Department of Gynaecology and Obstetrics of FMCH.
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
The Management (mainly the treatment aspect) of Female Infertility is described in brief here (as much as the limit of 55 slides permitted me to discuss!). References from:
Berek and Novak's Gynecology 15th editon
Speroff's Clinical Gynecologic Endocrinology and Infertility 8th edition
And of course, Slideshare itself!
Infertility affects as many as 10% of the couples, the causes, investigations and treatment with mention of management of fibroids and endometriosis has been done in the presentation.
Algorithms for Ovulation induction protocols (Assisted reproductive technolog...Anu Test Tube Baby Centre
Algorithms for ovulation Induction during Assisted Reproductive Technologies for treating infertility. Intrauterine Insemination (IUI) and In vitro Fertilization (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
This Case Presenataiton was presented in Central Presentation of Faridpur Medical College Hospital, in November 2019, by Dr. Faisal Abdullah, MBBS; who was an Intern Doctor of Department of Gynaecology and Obstetrics of FMCH.
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix
OBSTRUCTED LABOR is an emergency that poses significant risk to the life of both mother and fetus. A condition usually associated with low socioeconomic status puts much burden on the fragile health care delivery in subsaharan Africa
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
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
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
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.
Dear Doctors, this 6-minute video contains the Abdominal Cerclage and Isthmocoele Repair procedure performed on a patient, also the history and post-procedure advice. Do watch and add to your expertise. Thank you.
Visit: a4hospital.com
#adbomicalcerclage #patientvideo #procedure #surgeryday #Cervicalcerclage #newsletter #treatment #doctor #pregnancy #a4hospital #a4fertilitycentre #chennai #ivfcentreinchennai #chennaigynecologist #fertilitycentrechennai
Breastfeeding tips for new moms by Dr Lavanya, Pediatrician, A4 hospital and Fertility Centre, Chennai.
#breasfeeding #newbornbabycare #babycare #newmom #pediatrics #mommilk #newmom #fertilitycentre #pregnancytips #breastfeedingtips #a4fertilitycentre #a4hospital #chennai
Danger signs in the newborn by Dr. Lavanya, Pediatrician, A4 Hospital and Fertility Centre, Chennai.
#newborn #dangersigns #pregnancytips #pregnancycare #childcare #childtips #babycare #a4hospital #a4fertility #fertilitycentre #chennai
Postnatal - Newborn care by Dr Lavanya, A4 Fertility Centre, Chennai
**Content**
-Postnatal environment
-Everyday care
-Breastfeeding - Cradle hold
-Burping baby
-Cord care
-Eye care
-Everyday care - Hygiene
-Stools in baby
-Danger signs
-Preparing for discharge
Ovulation induction - not all fertility treatment is IVF by Dr Aishwarya Parthasarathy, Fertility specialist, A4 Fertility Centre, chennai
#ovulationinduction #FertilityTreamtent #a4fertilitycentre #a4hopsitals #chennai
Ectopic pregnancy by dr aishwarya, a4 fertility centre, chennai
#ectopicpregnancy #ectopy #fertilitytips #pregnancycare #pregnancytreatment #ivfcentre #pregnancytips #a4hospital #a4fertilitycentre #chennai
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
2. WHO Group I- Hypo hypo
● Mrs. V , 34y/F came with primary infertility h/o only withdrawal bleed for fertility
treatment
● Her FSH was 1.65 and LH was less than 0.30 and prolactin was 6.8, TSH was 1.94, FT4
was 1.24, AMH was 0.81, Testosterone was 0.1, E2 was <5, Progesterone was 0.3.
● So this indicated that she is having hypogonadotropic hypogonadism with low ovarian
reserve.
● Her AMH was low and FSH and LH was also low contrary to premature ovarian failure,
where FSH and LH will be high.
CASE 1
3. ● In the fertility centre the diagnosis of premature ovarian failure was made and
Diagnostic Hystero Laparoscopy, Hysteroscopy and endometrial biopsy was done
suspecting Asherman syndrome.
● The patient underwent histopathological examination it shows late proliferative
endometrium, however empirically ATT was started for the patient and given for 6
months. Then also she didn’t have menstrual cycle, only it was an induced cycle.
● Then karyotyping also done, it was 46XX. First consultation with us on 2020 feb.
CASE 1
5. ● Underwent 2 cycle of IUI with HMG(human menopausal Gonadotropins 150
4 doses, 225 9 doses, 375 5 doses) - which was unsuccessful
● Planned for ICSI-Self
● Started on Menotas XP 450 IU for 12 days, triggered with Inj.Ovitrelle
250mcg
● OR-8, MII-5, Fert-4, Frozen 1D5, 2D6(BC)
CASE 1
6. • FET was done a month later with 2D6 embryos
• Beta HCG was positive with confirmed clinical pregnancy at 6 weeks with SLIUG
• Done cervical cerclage with pessary insertion in view of short cervix at 26 weeks of
gestation
• Continued pregnancy with no complication till term
• Delivered healthy female baby of 2.7kg by Elective LSCS
CASE 1
7. WHO Group II- Resistant PCO
● Mrs.R 32yrs married for 14yrs,
● Underwent laparoscopy and drilling done in 2012,
● Wt 105 kg BMI 40, hypertensive and diabetic ,AMH was 4.64 OI done with letrozole and 5
doses of HMG 150 outside, but no DF.
● In the next cycle induced with Letrozole 5mg BD and HMG 150IU 4 doses D10 scan showed
no DF dose increased to 225IU for 3 days, developed follicle on D15, trigger was given and IUI
done which was negative.
● IUI 2nd cycle started with Letrozole 5mg BD and HMG 150 IU 3 doses, D11 scan showed MSF
, dose increased to 225IU for 5 doses, D21 scan showed 22mm DF on rt ovary, inj. HCG 10000
given and IUI done...
● UPT positive with scan showing SLIUG
CASE 2
8.
9. WHO GROUP 3
● Group III constitutes hypergonadotropic hypogonadism secondary to depleted ovarian
function.
● Most difficult group to manage
● DHEA, Androgen Gels, IVF with Dual stimulation Ovarian Stem Cells
CASE 3
10. Ovarian stem cells
• Mrs.D, 27yrs, Married for 2 years, with primary infertility/ low ovarian
reserve(AMH-0.6), with previous two failed IUI, planned for ICSI
• Stimulated for 10 days with Gonal F 225IU and Menotas 150IU for 10 days
• Retrieved only 3 oocytes, of which there was only one MII and formed 1D3 ‘B’
grade embryo
• Planned for laparoscopic ovarian stemcells and dual stimulation
• Ovarian stem cells was instilled in May 2021, AMH was improved to 0.9, AFC 4/3
(July)
• Started stimulation with Inj.Pergoveris 300IU in July 2021 for 10 days
• 4OR/ 2MII/ 2D3 embryos were frozen
• Transferred all 3D5 and beta hcg was positive with singleton pregnancy ongoing
15 weeks
11.
12. Tubes
● Blocked - Cannulation
● Hydrosalpinx - Clipping or Salpingectomy
● Non Functioning - Diagnosed after Ectopic
● Altered Tubo Ovarian Relation _ Diagnosed only with Laparoscopy
13. Tubal- Heterotopic Pregnancy (Endometriosis with SOAT)
● Primary infertility, married for 10 years with SOAT came for ICSI
● Stimulated for 10 days with GF225IU + Menotas 225IU, triggered with Deca 0.2mg -
obtained 14 oocyte- 10MII- 2D5 & 2D6 were frozen
● Done for Laparoscopy which showed stage IV endometriosis and B/L tubal clipping done
for B/L hydrosalpinx and hysteroscopy showed fibrosed Rt ostia otherwise normal
hysteroscopy
14. ● Following cycle, FET was done with 2D5 embryos, beta hcg was positive
● Viability scan at 6 weeks showed intrauterine gestation with ? Rt interstitial pregnancy
16. ● Confirmed diagnosis with 3D USG
● Taken up for laparoscopy
● Intra-op: 2x2cm POC buldge with impending rupture at right cornua,
vasopressin injected at cornua, POC scooped out
18. ● Post operatively, intrauterine pregnancy continued to grow
● Reached term without complication and delivered a live healthy baby by LSCS
CASE 4
19. Cornual Pregnancy
● Primigravida, married for 3 yrs, well educated , working as project manager.
● confirmed pregnancy at home, done scan elsewhere a week ago showing no e/o
intrauterine sac/ ? Ectopic pregnancy
● Waited for one week as beta hcg doubling was positive
● TVS done at 7 weeks with us showed SLIUG at 6+5 weeks toward left cornua, advised to
follow up after 2 weeks
CASE 5
21. Follow up scan at 10 weeks
● At 10 weeks follow up,
● TVS showed missed miscarriage – hence planned for D& E under anaesthesia
● Any other consent or procedures you will be ready with ?
CASE 5
23. ● Intra-op : cervix dilated and suction and evacuation tried with karman’s cannula
● USG showed intact sac at left cornua
● Proceeded to hysteroscopy, found a intact sac at left cornua, same removed with
grasper and uterine cavity found to be subseptate and cut with scissors after
getting consent for the same.
CASE 5
26. Recommendations on terminology for ectopic pregnancy - ESHRE
● Ectopic pregnancies should be classified as uterine and extra uterine(tubal/non
tubal/angular pregnancy are abandoned)
● Partial or complete ectopic pregnancies— implanted in cervical, previous LSCS scar,
Intramural, interstitial portion
● Intramural ectopic---pregnancy located within the uterus but breaches the endo-
myometrial junction and invades the myometrium of the uterine corpus above the
internal os
● Cervical ectopic pregnancy----pregnancies which invade the myometrium in the vicinity or
below the level of internal os ,It could be located either anteriorly or posteriorly.
● Caesaren scar pregnancy--- which invade the myometrium implanted anteriorly at the
visible or presumed site of transverse lower uterine scar
CASE 5
27. TUBAL PREGNANCY SHOULD BE DESCRIBED AS
● INTERSTITIAL ECTOPIC PREGNANCY---uterine part of fallopian tube 5%
● ISTHIMIC ECTOPIC PREGNANCY---rare5% %-15%
● AMPULLARY ECTOPIC PREGNANCY--- 70% common type of tubal ectopic)
● RUDIMENTARY HORN ECTOPIC PREGNANCIES—in case of uterine anomalus the
pregnancy located in a rudimentary horn of the uterus
● Residual ectopic pregnancy---ectopic pregnancy which presents as a discrete mass on
USG with negative pregnancy test and B HCG
● (In this type clinically to ellicite the history of previous month menstrual date and flow
and onset of pain )
CASE 5
29. Uterus - Submucous fibroid
● Mrs.X, 30 yrs taken MTP pills for missed
miscarriage came to us with continuos
bleeding and scan done outside as RPOC for
further management
● When patient came to us, TVS showed
CASE 6
30. ● TVS : Submucous fibroid with minimal RPOC.
● Hence,
PLANNED FOR HYSTEROSCOPIC MYOMECTOMY after MRI
CASE 6
34. OVARIAN DETORSION ON THE DAY OF OPU
● A case of secondary infertility with previous miscarriage due to
septate uterus came to us for further management
● Diagnostic laparoscopy with septal resection was done
● ICSI was planned due to failed IUI
● Ovarian stimulation was done using Gonal F 225 IU and
menotas HP 225 IU for 10 days
CASE 6
35. ● Trigger –Deca 0.1 + HCG 5000 IU
● Pt had pain abdomen and vomiting one day after trigger USG showed intact follicles .
CASE 6
36. ● With a working diagnosis of ?premature rupture / torsion ,early OPU was done 2 hrs
before scheduled ovum pick up. Pt consent was taken up for diagnostic laparoscopy in
v/o of persistant symptoms.
● OPU- OR-18,M2-9, 2D3 & 2D5 frozen.
● Laparoscopy findings: Right ovarian torsion ,double time twisted around the pedicle,
Detorsion done.
CASE 6
37. 2 cycles later – FET
● FET done with 2D5 embryos
● Pt is now 25 weeks ongoing pregnancy with twin gestation on follow up.
CASE 6
38. Asherman Syndrome- RIF
● Mrs. P 36yrs, MS 10yrs, h/o OD-ICSI done thrice in 2013, 2016, 2019... 2016 ET was positive
with right ectopic for which Rt salphingectomy was done...
● -In 2016, hysteroscopy was done outside in which cervix was dilated with difficulty,
uterus retroverted, arcuate, HPE - late proloferative endometrium.
● In 2019 ERA was done which was early receptive (128+/- 3hrs)-We planned for OD ICSI,
diagnostic hysteroscopy and embryo transfer
● -Through OD ICSI we got 6 embryos( 4D5 &2D6)
● -Diagnostic hysteroscopy was done on 11/12/2020- endocervical canal stenosed, multiple
false passage, cervix widened with scissors, os dilated, cx shaving done, endometrium
fluffy.
● -Following hysteroscopy, HRT was attempted twice in jan/feb
● - cancelled due to thin endometrium(5.5mm)
● -Planned for hysteroscopy with stem cell instillation on 11/3/2021 on day 5 of periods
preceeded by three days of gcsf injection... following which ET was 7mm on day 17 of
same cycle... FET was done same month with 2D5
● - but was negative. -Again in the following month HRT started from D2, patient received
three PRP(2 fresh and 1 frozen), on D18, ET was 7.6mm three line good, 2D5 embryos
transferred, post transfer patient received LMWH, IL, BG... betahcg on 25/5/2021 was
1234... positive
40. SOAT with IUI Pooled Sample
● Mrs.Reddy Rani Prashanth, 27yrs, married for 2 years, k/c/o hypothyroidism on Rx came to us with
Primary infertility with male factor
● In the first visit, basic investigations were done which showed normal female factor with AMH – 4.28, B/L
Tubes were patent in HSG. Initial SA showed Volume-1.5ml, 7M/1% motile/ 1% normal forms.
Hormone profile – FSH-3.67, LH-1.39, Prolactin- 29.06, E2-<10, Total Testosterone – 166.9,TSH – 5.2
● Patient was started on T.Anastrazole 1mg 0-0-1 (alternate days), Inj.HCG and Inj.HMG weekly once
● Gradually his SA improved. His subsequent analysis was 8.5M/5%/1% and improved upto 20M/8%/2%
● Planned for IUI. Done first cycle IUI with 2 fresh sample with TMSC – 5.8milliom sperms – Negative
● Second IUI done in following month with 2 fresh and 2 frozen sample with TMSC -2.4million sperm was
also negative
● As the patient was reluctant for ICSI, as a last try third IUI was done with fresh and frozen sample
containing TMSC of 2 million sperms – resulted in positive pregnancy
● Now patient is continuing her 8 weeks pregnant with good fetal heart rate
43. THANK YOU
A4 Fertility Centre
Address:
87, Arcot Rd, Udhayam Colony, AVM Avenue,
Virugambakkam, Chennai, Tamil Nadu 600092
Find us on:
aruna@a4fertility.com
www.a4hospital.com
/a4hospital