This document summarizes a research paper that proposes a framework to improve quality of experience and energy efficiency for heterogeneous wireless multimedia broadcast receivers. The framework groups users based on their device capabilities and channel conditions. It broadcasts scalable video streams that are encoded with different layers to support different groups. Time slicing is used to allow discontinuous reception and energy savings by turning radios off between bursts. A game theoretic model is used to optimize source encoding, transmission scheduling, and modulation/coding to maximize reception quality and network capacity while balancing energy usage. Evaluation shows the approach enables 75-95% energy savings.
This document discusses test-driven development (TDD) and refactoring in JavaScript. It begins with an introduction to TDD and refactoring, then defines common code smells like long methods, duplicated code, and bad names. It also discusses refactoring techniques like extracting methods and renaming variables. Test smells are covered as well, such as obscure tests, conditional test logic, and dependent tests. Overall, the document provides an overview of code smells and refactoring best practices to write cleaner, more maintainable JavaScript code.
Ketua RW 22 mengundang warga dan aparat terkait untuk mengikuti operasi bersih (OPSIH) pada 15 Maret 2015. RW 22 juga meminta bantuan dinas kesehatan untuk melakukan penyemprotan (fogging) guna mencegah penyakit akibat nyamuk di lingkungan mereka.
Lise Meitner was an Austrian/German physicist born in 1878 who made significant contributions to nuclear physics. She received her doctorate in 1905 as the second woman to earn a PhD from the University of Vienna. In 1938, Meitner, Otto Hahn, and Fritz Strassmann discovered nuclear fission when bombarding uranium with neutrons. This splitting of uranium atoms led to additional neutrons and the potential for an explosive chain reaction. Sadly, her discovery was later used in 1945 for the atomic bomb dropped on Hiroshima. Meitner received several honors for her work, including the Max Planck medal in 1949.
Mukesh Kumar is seeking an entry-level position where he can utilize his communication skills, self-motivation, and basic knowledge of computers, Tally ERP 9, and networking. He has completed 10th and 12th standard and is currently pursuing a B.Com degree. As a fresher, he has no prior work experience but is eager to contribute sincerely to an organization if given the opportunity.
J. Ronald Adir іѕ someone who hаѕ lіvеd and observed over multірlе gеnеrаtіоnѕ соvеrіng ѕоmе оf thе most dramatic advancements іn humаn history, a techno-dweeb whо wаѕ іmmеrѕеd fоr mаnу уеаrѕ іn thе сrеаtіоn, mаnufасturіng аnd іmрlеmеntіng of gee-whiz technology аnd at thе еnd соmе out wіth this wоndеrful book.
Kadınlarda Üriner İnkontinansta Yönetim- Prof. Dr. Ömer Lütfi TAPISIZ.pptxOmerLutfiTAPISIZ1
Her iki kadından biri hayatının bir döneminde üriner inkontinansı deneyimlemekte ve her 10 kadından biri de üriner inkontinans nedeni ile cerrahiye ihtiyaç duymaktadır. Bu sunumda kadınlarda üriner inkontinansın yönetimi ile ilgili detaylı bir bilgilendirme yapılmaktadır. Prof. Dr. Ömer Lütfi TAPISIZ
Yardımcı üreme tekniklerinde sperm ile yumurtaların aynı ortama konması anlamına gelen klasik tüp bebek (in-vitro fertilizasyon-IVF) ve mikroenjeksiyon ya da diğer adıyla İntrasitoplazmik Sperm Enjeksiyonu (ICSI) uygulanmaktadır. Tüp bebek ve mikroenjeksiyon arasındaki tek fark yumurtanın döllenme şeklidir. Mikroenjeksiyon (ICSI) yardımıyla tüp bebek tedavisi, üreme tekniklerinde gelinen en son noktayı göstermektedir.
Bu uygulamayla birlikte özellikle erkek kısırlığının da tedavi edilebilme şansı oldukça yükselmiş ve yepyeni ufuklar açılmıştır.
https://www.tupbebek-istanbul.com
Kürtaj Ciddi Bir Cerrahi Girişimdir - Dalaman , Köyceğiz, Gizli KürtajMesut Bayraktar
Kadın Hastalıkları & Doğum Uzmanı Olan Mesut Bayraktar Muğla İlinde Çalışmaktadır. Doktorun Tedavi Yetenekleri; Ayrıntılı Ultrason, Miyom, Polip, Kist, Kürtaj, İltihap, Sürekli Tekrar Eden Mantar, Menopozal Renovasyon, Orgazm Aşısı, Vajen Sıkılaştırma, İdrar Kaçırma, Kolposkopi, HPV BaşTa Olmak Üzere Olup; Tüm Jinekolojik Problemlerinizi Çözmek Beni Mutlu Edecektir. WhatsApp: 05467740159 Üzerinden Randevu Talep Etmek İçin İletişime Geçebilirsiniz. Muayenehane Adresi: Beşköprü Mahallesi, Cumhuriyet C, No:62 Kat:3 Daire:5 48600 Ortaca/Muğla. Kadın Hasta ise Evde Huzur Yoktur.
The World Health Organization (WHO) defined «healthy ageing»
as the process of developing and maintaining the functional ability
that enables wellbeing in older age.
Functional ability is referred to as the ability to:
- meet their basic needs,
- learn, grow and make decisions,
- be mobile,
- build and maintain relationships, and
- contribute to society
WHO describes this functional ability as being formed by interactions between intrinsic capacity and environmental characteristics.
The intrinsic capacity includes the mental and physical capacities of a person.
The environmental characteristics are related to home, community and society as a whole.
Management of menopausal symptoms for breast cancer survivorsTevfik Yoldemir
This document summarizes management strategies for menopausal symptoms in breast cancer survivors. It discusses pharmacological options like clonidine, oxybutynin, antidepressants, black cohosh, and phytoestrogens. It also covers mind-body practices like cognitive behavioral therapy and hypnosis. Non-hormonal treatments for vulvo-vaginal symptoms are discussed, as well as short-term low-dose local estrogen therapy. Management of menopausal symptoms requires a personalized approach balancing symptom relief with safety.
The document discusses several studies related to endometriosis and IVF outcomes. It provides summaries of studies that examined:
- Live birth rates, clinical pregnancy rates, number of oocytes retrieved, and miscarriage rates for patients with endometriosis undergoing IVF compared to controls.
- IVF outcomes based on the severity of endometriosis compared to controls.
- Outcomes of fresh versus frozen embryo transfers.
- The risk of embryonic aneuploidy in patients with endometriosis.
- Treatment guidelines from ESHRE on the use of IVF and surgery for infertility associated with endometriosis.
Pelvic anatomy in relation with pelvic organ prolapseTevfik Yoldemir
The document discusses pelvic organ prolapse from an anatomical perspective. It describes the layers of fascia and muscles that provide support to the pelvic organs. Damage to the fascia can result in cystocele, rectocele, or uterine prolapse as the pelvic organs lose support and protrude into the vaginal canal. The document outlines the components of the pelvic floor according to the Integral Theory and how dysfunction, such as stress urinary incontinence, can result from weakness or damage in specific areas. Assessment tools like the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire are also mentioned for evaluating patients.
Certain viruses can be transmitted from mother to fetus during pregnancy and cause fetal or neonatal damage. These include cytomegalovirus, rubella virus, varicella zoster virus, herpes simplex virus, and parvovirus B19. Cytomegalovirus is the most common cause, with an estimated 1% of newborns infected worldwide. Severe damage from cytomegalovirus, such as cytomegalic inclusion disease, occurs in about 1 in 5,000 to 1 in 20,000 births. Transmission is more likely when a mother has a primary infection compared to a recurrent infection. Clinical manifestations in the newborn are also more common following primary maternal infection.
This document discusses different types of energy modalities used in surgery including monopolar, bipolar, ultrasonic, and plasma kinetic technologies. Monopolar energy uses an active electrode at the surgical site and a return electrode elsewhere on the patient's body, allowing for tissue cutting, coagulation, and desiccation. Bipolar energy passes between two close electrodes, minimizing collateral damage. Advanced bipolar technologies like Ligasure, Plasma Kinetic Gyrus, and Enseal can additionally seal and transect tissue. Ultrasonic devices use high frequency vibrations to denature proteins for coagulation and mechanical cutting. The effects of different energies on tissue are described, noting temperatures at which protein denaturation and
This document discusses techniques for diagnosing endometriosis, including magnetic resonance imaging (MRI) and transvaginal ultrasound (TVS). It provides details on MRI protocols, including patient preparation, positioning, and rectal opacification. It also outlines four basic steps for a TVS exam when evaluating for deep infiltrating endometriosis: 1) evaluating the uterus and adnexa; 2) assessing for soft markers like tenderness and ovarian mobility; 3) using the "sliding sign" to assess the pouch of Douglas; and 4) searching for endometriosis nodules. The document also discusses agreement between observers for diagnosing deep infiltrating endometriosis using TVS in different pelvic
This document summarizes research on the effects of alternative hormonal treatments, including bazedoxifene, on various tissues in humans. It discusses preclinical and clinical data on the effects of ospemifene, tamoxifen, raloxifene, and bazedoxifene on the endometrium, vagina, breast, and bone. It then summarizes results from several clinical trials, known as the SMART trials, that evaluated the efficacy and safety of a combination of conjugated estrogens and bazedoxifene for vasomotor symptoms, quality of life, vaginal health, and bone mineral density and fracture risk reduction.
1. The document discusses premature ovarian insufficiency (POI), including delays in diagnosis contributing to low bone density. For every month of delayed diagnosis, spine bone mineral density decreases by 0.026.
2. POI can manifest as delayed puberty, primary or secondary amenorrhea, or irregular periods. Genetic factors are responsible for some cases, with mutations in meiotic and DNA repair genes linked to syndromic and non-syndromic POI.
3. Treatment of POI involves hormone replacement therapy to mimic normal estrogen and progesterone levels. Estrogen therapy should begin at age 12-13 and be gradually increased over 2-3 years. Progestogen is later added for endometrial protection
This document discusses menopause and osteoporosis, including clinical risk factors for osteoporosis, indications for bone mineral density testing, hip fractures and biochemical markers of bone turnover. It also addresses calcium content of food, pharmacologic agents for osteoporosis, changes in lumbar spine and total hip bone mineral density, vertebral and non-vertebral fractures, and risks and benefits of hormone replacement therapy, including its effects on cardiovascular disease, cancer risks, and risks of breast and endometrial cancer. Contact information is provided for further questions.
This document discusses tests that should be performed before various forms of contraception including IUD insertion, implant insertion, DMPA initiation, OCP use, and POP initiation. It also mentions that follow-up is important and that PID can sometimes be found in IUD users. The document is authored by Tevfik Yoldemir MD BSc MA and provides his contact information and links to additional information on contraception.
The document provides treatment guidelines for several sexually transmitted infections (STIs):
- Chancroid is diagnosed based on painful genital ulcers and lymphadenopathy. It is treated with azithromycin, ceftriaxone, ciprofloxacin, or erythromycin.
- Herpes is typically treated with acyclovir, valacyclovir, or famciclovir for suppressive or episodic therapy. Pregnant women may take acyclovir or valacyclovir.
- Syphilis treatment depends on stage, and involves benzathine penicillin for most cases.
This document contains a summary of topics related to early pregnancy complications and abortion. It lists bleeding in early pregnancy, ectopic pregnancy, risk factors and algorithms for diagnosis, methotrexate protocol, molar pregnancy symptoms and management, and habitual abortion as sections within the document. Contact information is provided for Dr. Tevfik Yoldemir as the author along with links to additional resources on these medical topics.
This document discusses menstrual cycle disorders and their causes and treatment. It defines menorrhagia as heavy menses in ovulatory women, and metrorrhagia as irregular bleeding during an ovulatory cycle. Common causes of abnormal uterine bleeding (AUB) include uterine fibroids, endometrial polyps, and adenomyosis. Evaluation of AUB may involve a saline-infused sonogram. Medical treatments aim to regulate hormone levels and bleeding patterns through contraceptives and cyclic progestin-only regimens.
This document discusses chronic pelvic pain and associated disorders. It covers chronic pelvic pain disorders, different physical examination positions, diagnostic tests, endometriosis, and provides contact information for questions. The document appears to be notes from a presentation or article on evaluating and diagnosing chronic pelvic pain and conditions that may cause it such as endometriosis.
This document summarizes research on endometriosis beyond late reproductive age. It discusses findings that endometriosis persists and can recur even after menopause. Studies show endometriosis symptoms continue across all age groups and surgical recurrence rates remain high. Hormone replacement therapy after menopause may increase risk of endometriosis recurrence and malignant transformation. Emerging treatments for endometriosis that are discussed include GnRH antagonists, aromatase inhibitors, and other drug classes targeting factors like angiogenesis and inflammation.
This document summarizes several studies on the impact of fibroids on fertility and in vitro fertilization (IVF) outcomes. It discusses factors like sample size calculations, reliability and validity of research data, and potential confounding factors in sham surgery trials. It then summarizes multiple studies that found no significant impact or decreased live birth rates with intramural fibroids not distorting the uterine cavity compared to controls without fibroids undergoing IVF. The document provides an expert review of the evidence on fibroids and fertility.
1. The document discusses fertility options for women over age 40, what is realistic and not realistic. It provides data from studies on pregnancy rates by age and discusses strategies like tailored stimulation protocols, embryo selection techniques, and oocyte accumulation.
2. Case studies are presented of women over 40 concerned about their fertility. The document recommends counseling based on AMH, AFC, prior response and discussing tailored protocols, cumulative success rates, and alternative options.
3. Strategies discussed include minimal or double stimulation protocols, embryo banking, oocyte donation, and new selection techniques, but individualized assessment is important due to variability.
- Maternal nutrition and environmental exposures during pregnancy can impact the fetal epigenome through DNA methylation, histone modifications, and microRNAs. This can increase the risk of health issues like metabolic syndrome later in life.
- Certain phytochemicals from foods like epigallocatechin gallate, resveratrol, genistein, and curcumin may beneficially influence the fetal epigenome by regulating enzymes involved in epigenetic modifications.
- Adequate intake of nutrients like vitamins, minerals, and phytochemicals during pregnancy and lactation may help protect the offspring by modulating the fetal epigenome.
1. 20.03.2015
1
Intrauterin İnseminasyon
Dr Tevfik Yoldemir
Marmara Üniversitesi
Kadın Hastalıkları ve Doğum A.D.
tevfik@yoldemir.com
Reproductive BioMedicine Online (2014) 28, 300– 309
Canlı doğum –IUI vs COS-IUI
EF
Aİ
N=664
IUI yapalım mı?
Canlı doğum oranı
AİIUI yapalım mı?
EF
Aİ
8 RKÇ, 2550 çift
IUI yapalım mı?
6 ay içinde canlı doğum
EF
Aİ
IUI yapalım mı?
Kötü prognoz, IUI+KOS > BG / KS+Zİ
İyi prognoz, BG > diğerleri
2. 20.03.2015
2
4 ay içinde devam eden gebelik
EF
Aİ
IUI yapalım mı?
İyi prognoz, IUI+KOS >
Kötü prognoz, IVF>
6 ay içinde canlı doğum
EF
Aİ
IUI yapalım mı?
Kötü prognoz IUI+KOS veya IVF> IUI - KOS
İyi prognoz IUI-KOS > diğerleri
4 siklus içinde canlı doğum
EF
Aİ
IUI yapalım mı?
IUI veya ICI+KOS >
Reproductive BioMedicine Online (2014) 28, 300– 309
Fertil Steril 2014;101:994–1000 Fertil Steril 2014;101:994–1000
4. 20.03.2015
4
Aİ / kötü prognoz sET vs IUIx3
Aİ
rFSH
Kimlere?
Canlı Doğum- Erkek subfertilitesi
EF
KS+HMG
Kimlere?
IUI = IUI+KOS
Evre 3-4 endometriozis
Reproductive BioMedicine Online (2014) 28, 590– 598
Evre 3-4 endometriozis
Reproductive BioMedicine Online (2014) 28, 590– 598
Evre 3-4 endometriozis
Reproductive BioMedicine Online (2014) 28, 590– 598
Natural ve IVF
Evre 3-4 endometriozis
Reproductive BioMedicine Online (2014) 28, 590– 598
5. 20.03.2015
5
FASTT trial
FSH-IUI atlanabilir
Aİ
KS
FSH21-39 yaş
Kimlere?
FORT-T Trial
Hemen IVF , olamayacaksa > CC-IUI ve sonra IVF
Aİ
KS
FSH
Kimlere?
38-42 yaş
Canlı doğum
Aİ
KS
FSH
Hemen IVF , olamayacaksa > CC-IUI ve sonra IVF
Kimlere?
≥ 40 yaş
Reproductive BioMedicine Online (2012) 24, 170– 173
Reproductive BioMedicine Online (2014) 28, 300– 309
Human Reproduction Update, Vol.1, No.1 pp. 1–13, 2009
6. 20.03.2015
6
Erkek subfertilitesi/ Açıklanamayan
KS vs rFSH (+ IUI)
EF
Aİ
KS
rFSH
Hangi protokol?
Açıklanamayan
Erkek subfertilitesi
Aİ
EF
Hangi protokol?
FSH / HMG - IUI
FSH
rFSH
HMG
OF
EF
MF
Hangi protokol?
Rek vs hp FSH - IUI
Aİ
EF
EF
OF
EF
TF
hpFSH
rFSH
Hangi protokol?
Siklus başına gebelik oranı hpFSH
rFSH
Hangi protokol?
Kadın başına gebelik oranı hpFSH
rFSH
Hangi protokol?
7. 20.03.2015
7
İlk siklusta gebelik oranı hpFSH
rFSH
Hangi protokol?
KS – IUI
KS
OF
EF
PKOS
Hangi protokol?
Aİ – KS vs LTZ KS
LTZ
AİHangi protokol?
Canlı doğum -KS vs Met vs Kombine
PKOS
KS
KS+M
Hangi protokol?
PKOS- KS vs AI
7.5 mg 150 mg
PKOSHangi protokol?
Optimal Folikül çapı –
KS (n=777) LTZ (n=211)
KS = LTZ
OF
EF
TF
PKOS
KS
LTZ
Hangi protokol?
8. 20.03.2015
8
KS vs FSH +IUI
Human Reproduction Update, Vol.1, No.1 pp. 1–13, 2009
FSH+ IUI vs IUI
Human Reproduction Update, Vol.1, No.1 pp. 1–13, 2009
PKOS
FSH vs FSH+Anta
PKOSHangi protokol?
IUI- Cetrorelix
rFSH
OF
EF
Aİ
Hangi protokol?
Erkek subfertilitesi/ Açıklanamayan
rFSH vs rFSH+ Anta (+IUI)
rFSH
EF
Aİ
Hangi protokol?
Erkek subfertilitesi/ Açıklanamayan
Gnd vs Gnd + Anta (+IUI)
EF
Aİ
Hangi protokol?
9. 20.03.2015
9
Devam eden gebelik FSH+IUI ±Anta
Human Reproduction Update, Vol.1, No.1 pp. 1–13, 2009
Reproductive BioMedicine Online (2014) 28, 300– 309
Luteal faz desteği
Fertil Steril 2013;100:1373–80
Luteal faz desteği
Fertil Steril 2013;100:1373–80
Reproductive BioMedicine Online (2014) 28, 300– 309
Tek vs çift IUI
Fertil Steril 2014;102:739–43
10. 20.03.2015
10
Çift = Tek IUI
Fertil Steril 2010;94:1261–6
Reproductive BioMedicine Online (2014) 28, 300– 309
KS- Ovulasyon kiti vs HCG / IUI
Fertil Steril 2006;85:401– 6
Hcg vs LH monitor-
Gebelik olasılığı
EF
OF
Hangi protokol?
Hcg vs LH monitor-
Gebelik olasılığı
Aİ
Hangi protokol?
Optimum folikül çapı
Fertil Steril 2012;97:1089–94.
11. 20.03.2015
11
Optimum folikül çapı
Fertil Steril 2012;97:1089–94.
Optimum folikül çapı
Fertil Steril 2012;97:1089–94.
Optimum folikül çapı
Fertil Steril 2012;97:1089–94. Reproductive BioMedicine Online (2014) 28, 300– 309
Erken vs Geç HCG
16.0 -16.9 mm (Erken hCG grup) vs 18.0 - 18.9 mm (Geç hCG grup)
EJOG RB 164 (2012) 156–160
Reproductive BioMedicine Online (2014) 28, 300– 309
12. 20.03.2015
12
Swim-up vs Gradient Swim-up vs wash
Gradient vs wash Taze semen / swim-up vs gradient
Taze semen / swim-up vs wash Taze semen / gradient vs wash
13. 20.03.2015
13
Reproductive BioMedicine Online (2014) 28, 300– 309
Abstinans günü – gebelik oranı
Fertil Steril 2010;93:286–8
WHO 1999 vs WHO 2010
http://dx.doi.org/10.1016/j.rbmo.2014.12.007
normal TMSS (1999 WHO)
(‘normal (N.) 1999 TMSS’) = 2 ml × 20
milyon/ml × ≥50% ileri motil,
20 milyon ileri motil sperm
anormal TMSS (1999 WHO), normal 2010
WHO)
(‘anormal (AN.) 1999/N. 2010 TMSS’) = 7.2
- 19.999 milyon ileri motil sperm
anormal TMSC (2010 WHO)
(‘AN. 2010 TMSS’) = 1.5 ml × 15 milyon/ml
× 32% ileri motilite, <7.2 milyon ileri motil
sperm.
Nativ vs post-wash
semen parametreleri
EJOG RB 179 (2014) 159–162
İleri hızlı sperm – Gebelik oranı
UROLOGY 80: 1262–1266, 2012.
Sperm morfoloji
Fertil Steril 2014;102:1584–90
14. 20.03.2015
14
Sperm morfoloji
Fertil Steril 2014;102:1584–90
Sperm hazırlama ile IUI arası süre
Fertil Steril 2014;101:1618–23.
Sperm hazırlama ile IUI arası süre
Fertil Steril 2014;101:1618–23.
SCSA - IUI
Human Reproduction Vol.19, No.6 pp. 1401±1408, 2004
Reproductive BioMedicine Online (2014) 28, 300– 309
İşlemi uygulayana göre gebelik
oranları
Am J Obstet Gynecol 2014;211:492.e1-9.
15. 20.03.2015
15
Folikül rüptürü ve uterin
kontraksiyonlar
Fertil Steril 2014;102:1034–40
Folikül rüptürü ve uterin
kontraksiyonlar
Fertil Steril 2014;102:1034–40
İşlem
• IUI( intrauterine insemination) işlemi için taze ya da
donmuş ejekülat toplanmalıdır.
• İşlem görmüş spermler inseminasyona kadar vücut
sıcaklığına yakın bir sıcaklıkta saklanmalıdır
• Hasta bel hizasından itibaren giysi olmayacak şekilde
muayene masasına dorsal litotomi pozisyonunda
yatırılmalıdır.
İşlem
• 1cc lik şırıngaya yaklaşık 0.3-0.5 ml hava çekilmelidir.
• Künt uçlu steril iğne şırınganın ucuna
yerleştirilmelidir
• Bir adet şırıngaya kendi süspansiyonuyla beraber
işlenmiş spermler aspire edilmelidir.
• Serviksten reflü ve inseminasyon sonrası oluşan
uterin kontraksiyonlara karşı önlem olarak spermler
en fazla 0,5 ml süspansiyon sıvıyla beraber enjekte
edilmelidir.
İşlem
• Şırınga 18 cm'lik polietilen inseminasyon kateterine
takılmalıdır.
• İki çeşit kateter vardır. Kıvrılmayan göreceli olarak
sert tek katmanlı kateter(düz ve ya kıvrımlı) ve kıvrım
sağlayan eksternal esnek kılıf ve oldukça yumuşak
internal kılıfa sahip kateter.
• 2010 yılında 6 randomize çalışmanın meta-analizine
göre gebelik ve doğum başarısı her iki kateterde de
benzerdir; ancak diğer faktörler de göz önünde
bulundurulmalıdır.
İşlem
• Hastanın uterusunun şekli uygun ve endometriuma
daha az hasara neden olan kıvrımlı ve yumuşak
kateteri tercih edilmelidir.
• Kateterin içerisine yerleştirebilecek bir tel yada sert
stilet zor IUI'lerde kullanılabilir.
• Serviksin internal ağzından geçilmesi zor ise dolu bir
mesaneye sahip hastada abdominal ultrason kullanımı
yardımcı olur.
• Daha sert olan kateterler katlanmadığından uterin
kaviteye yerleştirilmesi daha kolaydır; ancak işlem
hasta için daha ağrılı daha travmatiktir.
16. 20.03.2015
16
İşlem
• Serviksin bütünüyle vizüalize edilebilmesi için vajinal
spekulum takılmalıdır.
• Uterin kaviteye girecek olan kateterin ucuna
dokunmadan kateter servikal ağızdan endoservikal
kanala oradanda uterin kaviteye sokularak yaklaşık 6-
6.5 cm ilerletilmelidir
• Katater yerleştirilmesi sırasında zorluk yaşandığı
takdirde rijit stilet kullanımı ve ya abdominal ultrasonla
görüntüleme yardımcı olabilir.
• Tenakulum kullanılmasından kaçınılması gerekir; çünkü
uterin kontraksiyonlarına ve hastanın rahatsızlık
hissetmesine sebep olabilir
İşlem
• Spermleri enjekte ettikten sonra yavaşça kateteri
geri çıkarılmalıdır
• Spermler fallop tüplerine neredeyse 5 dakika kadar
kısa bir sürede ulaşabilir. Hastalar süpin ve ya ters
tredelenburg pozisyonuna alıp bekletilmelidir.
• Ruhsal tatmin amaçlı hastalar genelde işlemden
sonra belli bir süre dinlendirilir
Eve götürülecek mesajlar -1
• KS/FSH/HMG+ IUI gebeliği arttırır FS 2007
• FAİ, VKİ, mens siklus KS – canlı doğum ilişkili HRUpd 2008
• İns, BKÇ, SHBG, hirsutizm KS+Met daha iyi HR 2010
• Sİ, EF, KS veya FSH ile KOS Gebelik NS HR 2008
• IUI, KOS+IUI canlı doğumu arttırır FS 2012
• IVF= IUI naive , IVF > IUI öncesinde tedavi almış HRUpd 2013
• Kötü prognozlu IUI+KOS > BG veya Zİ+KS ;
İyi Prognozlu BG > diğer yaklaşımlar HR 2014
• İyi prognoz IUI+KOS > ; kötü prognoz IVF > HR 2014
• Kötü prognoz IUI+KOS veya IVF> IUI – KOS;
İyi prognoz IUI-KOS > diğerleri HR 2014
Eve götürülecek mesajlar -2
• Anovulatuar PKOS FSH> KS HR 2012
• OAT ; IUI = IUI+KOS FS 2009
• FASTT, FSH+IUI atlanabilir FS 2010
• FORT-T; FSH-IUI atlanabilir FS 2014
• Aİ, KS=LTZ FS 2009,2012
• Teratospermi, TMS> 5 mil; FSH/HMG FS 2010
• Eİ, Aİ; KS= rFSH HR 2007
• PKOS; rFSH = hpFSH HR 2007,FS 2011
• PKOS; rFSH = rFSH+Anta (+IUI) HR 2007,FS 2011
• HCG enj = LH takip FS 2007
• Tek IUI = Çift IUI FS 2010
• Prog suppl. Aİ; FSH evet, KS hayır FS 2013
Dikkatiniz için teşekkür ederim.
www.slideshare.net/dryoldemir
tevfik@yoldemir.com