The document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. It notes that abnormal luteal function can occur after controlled ovarian stimulation, necessitating LPS. It reviews various LPS options including human chorionic gonadotropin and progesterone administered via different routes. Vaginal progesterone is found to effectively increase endometrial levels while intramuscular progesterone yields the highest serum levels. The document concludes that LPS is necessary to optimize ART outcomes and that intramuscular or vaginal progesterone are equally effective options.
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.
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
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.
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
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
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
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
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
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
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
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
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
Clomiphene citrate or aromatase inhibitors for superovulation in women with u...Aboubakr Elnashar
Clomiphene citrate or aromatase inhibitors for
superovulation in women with unexplained infertility
undergoing intrauterine insemination:
a prospective
randomized trial
De novo synthesis of fatty acids (Biosynthesis of fatty acids)Ashok Katta
Synthesis of fatty acids in the body. Detailed pathway for de novo synthesis of fatty acids in the body including its energetic and regulation. also cover Multienzyme complex
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
3. 1. WHY?
Abnormal luteal function after COS for IVF
Suppression of LH
Continued down-regulation by GnRHa
Removal of of granulosa cells at OR
Supra physiological E2/P4 in early luteal phase
hCG injection before OR
Aboubakr Elnashar
4. 2. INDICATIONS
1.Agonist and antagonist protocols
A. PR are significantly reduced in GnRHa ovarian
stimulation without LPS
(Daya & Gunby,2004)
B. Both GnRHa and antagonist IVF cycles: abnormal LPD
in all stimulated IVF cycles
C. Luteolysis is also initiated prematurely in antagonist co-
treated IVF cycles}
(Albano et al., 1998; Beckers et al., 2002)
Aboubakr Elnashar
5. 2. Frozen natural cycles?
Controversial
LPS increases LBR after frozen ET
(Bjuresten et al. 2010)
LPS has no effect on ongoing PR in hCG-induced
natural frozen-thawed ET cycles
(Kyrou et al. 2010)
Endometrial preparation for women undergoing ET
with frozen embryos or embryos derived from
donor oocytes (Glujovsky et al.,2010)Aboubakr Elnashar
6. 3. WHEN TO START
From day of OR or ET
Not be later than day 3 after OR
Aboubakr Elnashar
7. 4. WHEN TO STOP
Minimum’ 14 days from the day of ET until the day
of a positive HCG test.
(Andersen et al., 2002)
‘Minimum’ 18 days following OR
(Mochtar et al., 2006)
1st T progesterone supplementation in IVF support
early pregnancy through 7 w by delaying a
miscarriage but not improve LBR
(Andersen et al, 2002, Aboulghar et al, 2008)
8-10 w of gestation.
Aboubakr Elnashar
8. 5. WHAT TO USE FOR LPS?
hCG
Progesterone
Aboubakr Elnashar
9. HCG:
Rescue corpus luteum
(Hutchins Williams et al. 1990)
improves the implantation by increasing relaxin,
integrin & placntal ptn
(Mochtar, 1998)
increase the risk of OHSS
(van der Linden et al., 2012)
Aboubakr Elnashar
12. CompanyPrice
(LE)
FormMgGeneric
name
FormTrade name
Ibsa7230 vag pessaries200ProgesteronVag or
rectal
Prontogest
Ibsa10230 vag pessaries400
Ibsa82.510 amp100ProgesteronIM
Actavis9015 vag pessaries200ProgesteronVag or
rectal
Cyclogest
Actavis12515 vag pessaries400
Ferring20021 vag tab100ProgesteronvagEndometrin
Serono236jell15 tube8 %ProgesteronevagCrinon
Octoper2430 caps100ProgesteroneVag or oralUterocare
Pharco1824100ProgesteroneVag or oralProgest
Aboubakr Elnashar
13. Progestagen: Definite benefit
(van der Linden et al., 2012)
Improves endometrial receptivity
(Kolibianakis & Devroy, 2002)
Promotes local VD and uterine musculature
quiescence by inducing nitric oxide synthesis in
decidua
(Bulletti & de Ziegler, 2005)
act as immunologic suppressant blocking Th1 and
inducing release of Th2 cytokines
(Ng et al. 2002)
No value as regards miscarriage
(van der Linden et al., 2012)
Aboubakr Elnashar
14. hCG Vs progesterone
hCG is better
(Soliman, 1994)
No differences but OHSS is twice more common in
hCG group
(Pritts & Atwood, 2002)
hCG is equal to I.M. progesterone
(Daya & Grundy, 2004; van der Linden et al., 2012)
Aboubakr Elnashar
15. hCG +progesterone Vs progesterone alone
Both are equally effective
(van der Linden et al., 2012)
Aboubakr Elnashar
16. 1. Oral progesterone
Only 10% of oral dose circulates as active P4 {first
pass effect}
No secretory transformation of the endometrium
in patients with POF who had been treated with
oral micronized progesterone
(Devroey et al.1989; Bourgain et al. 1990)
Aboubakr Elnashar
17. 2. IM progesterone
Serum P4 levels well above the physiological
range with adequate endometrial secretory
changes
Dose:
natural progesterone in oil, 25 and 100 mg/d: No
significant difference in outcome
(Costabile et al., 2001, Pritts & Atwood, 2002)
Aboubakr Elnashar
18. Side effects:
painful injections
inflammatory reactions
rash
needs to be administered by nurse
(Lightman et al., 1999)
Aboubakr Elnashar
19. 3. Vaginal progesterone
“Targeted drug delivery” from vagina to uterus:
better endometrial histology
High uterine progesterone concentrations
{anatomically close blood vessels: uterine first
pass effect}
(Cicinelli et al., 2000, de Ziegler et al., 1995)
Aboubakr Elnashar
20. Micronized progesterone:
no dose finding studies.
Most frequently: 300–600 mg daily, spread over 2-
3 dosages
(Tavaniotou et al., 2000)
Vaginal progesterone pessaries:
no dose finding studies
frequently used: 400-800 mg daily, spread over 3-4
doses
(NG et al, 2002, Tay et al, 2005)
Aboubakr Elnashar
21. Vaginal gel
8% gel in a dose of 90 mg once daily
no differences when administered twice daily
(Tavaniotou et al, 2000)
Low dose or high dose vaginal progesterone gel
Both are equally effective
(van der Linden et al., 2012)
Aboubakr Elnashar
22. Which vaginal preparation?
Gel or capsules ?
Both are equally effective
(Daya & Grundy, 2004)
Capsule:
solid evidence of effectiveness and convenience
(Elenany et al, 2011)
more cost effective than gel: Gel is at least 4 times
more expensive than Capsules
No difference exists regarding CPR between
vaginal P gel and all other vaginal preparations for
LPS
(MA: Polyzoz et al, 2010)
Aboubakr Elnashar
23. 4. Rectal application
resulted in serum concentration during the first 8h
twice as high as other forms.
no prospective RCT to compare the rectal
administration of progesterone with other
administration routes for IVF
(Chakmakijan & Zachariah, 1987)
Aboubakr Elnashar
24. 5. SC
A new water-soluble progesterone
Implantation rate, PR, LBR and early miscarriage
rate for Prolutex were similar to those for Crinone.
The adverse event profiles were similar and
Prolutex was safe and well tolerated.
Aboubakr Elnashar
25. Oral or I.M. progesterone ?
Definitely I.M. progesterone
(Daya & Grundy, 2004)
Oral or vaginal progesterone ?
Definitely vaginal progesterone
(Daya & Grundy, 2004)
I.M. or vaginal progesterone ?
Both are equally effective
No difference in CPR
(Daya & Grundy, 2004; MA: Zarutiski & Philips, 2009)
Aboubakr Elnashar
27. IM progesterone is associated with the highest
serum levels (Fert.Steril, 2012)
Aboubakr Elnashar
28. For IDEAL LPS:
IM P for the Highest Serum levels and Vaginal P for
increasing the Endometrial levels, Until Placental
progesterone production adequate, around week
8-10 w of gestation.
(Fert.Steril, 2012)
Aboubakr Elnashar
30. 6. CO-TREATMENTS TO
PROGESTERONE
1.Addition of E2 to progesterone
No effect of oral estrogens
(van der Linden et al., 2012)
Transdermal estrogen is beneficial
(van der Linden et al., 2012)
No effect in antagonist protocol
Aboubakr Elnashar
31. 2. Low dose aspirin
VD and decreased platelet aggregation increased
ovarian and endometrial blood flow ovarian
responsiveness, endometrial thickness, IR
Decrease uterine contraction at the time of ET
Low-dose aspirin (100 mg/d) doesn’t improve
ovarian responsiveness, blood flow, and PR
(Dirckx et al., 2009; Lambers et al., 2009)
Aboubakr Elnashar
32. 3. Piroxicam
An oral dose 10 mg 1-2 h before ET
significantly improves PR
(Moon., 2004)
Doesn’t improve PR
(Dal and Borini, 2009)
Aboubakr Elnashar
33. 100 mg q12h rectally for 3 doses from the night
before ET does not improve PR in oocyte
recipients
(Bernabue, 2006)
4. Indomethacin
Aboubakr Elnashar
34. 4. low dose heparin
5000 IU bid and aspirin 100 mg/day from
the day of ET did not improve PR or IR
(Stern et al., 2003)
Aboubakr Elnashar
35. 5. Prednisolone
10 mg/d before or after ET does not increase PR
(Ubaldi et al., 2002)
Aboubakr Elnashar
36. 6. Viagra
25 mg qid vaginally from stimulation D1 to hCG day
(Sher, 2002; Paulus,2002)
Aboubakr Elnashar
37. 7. Ascorbic acid
Luteal regression is associated with ascorbate
depletion and the generation of reactive oxygen
species, which inhibit the action of LH and block
steroidogenesis
No value
(Griesinger et al.,2002)
Aboubakr Elnashar
38. 8. GnRHa in midluteal phase
GnRH receptor is expressed in the human
preimplantation embryos, endometrium, corpus
luteum
GnRHa has been shown to stimulate trophoblast
production of hCG
Increased LBR
(MA: Kyrou et al., 2008)
Aboubakr Elnashar
39. GnRHa Vs no tt
GnRHa is beneficial
(Glujovsky et al., 2010)
Effective
(van der Linden et al., 2012)
Which GnRHa is more beneficial?
No differences
(Glujovsky et al., 2010)
Aboubakr Elnashar
40. CONCLUSION
LPS is necessary to optimize the outcome of ART
LPS with hCG is not superior to P.
Supplementary hCG brings no advantage to P with
hCG increases risk of OHSS as compared with P
Aboubakr Elnashar
41. The use of oral P is clearly inferior to IM or vaginal
administration and is associated with an increased
rate of side effects due to its metabolites
IM and vaginal P therapy seem to be equally
effective
Aboubakr Elnashar
42. The administration of estrogen to supplement the
luteal phase in standard stimulated IVF cycles needs
further clarification and evidence
No evidence to support co-tt to progesterone
including aspirin, heparin, viagra….apart from
midluteal phase GnRHa which is promising
and needs further evaluation
Aboubakr Elnashar