Management of poor ovarian reserve- Dr Parul KatiyarDr Parul Katiyar
Premature ovarian aging or ovarian failure is a major cause of female factor infertility. Dr Parul explains the mechanism of premature ovarian failure and discusses some simple measures to preserve/ regain fertility among women.
Management of poor ovarian reserve- Dr Parul KatiyarDr Parul Katiyar
Premature ovarian aging or ovarian failure is a major cause of female factor infertility. Dr Parul explains the mechanism of premature ovarian failure and discusses some simple measures to preserve/ regain fertility among women.
Role Of AMH In Infertility , Dr. Sharda Jain , Life Care Centre Lifecare Centre
Role Of AMH In Infertility , Advantage of AMH , Fecundity / Infertility & AMH , Infertility and AMH ,Prediction of pregnancy chances in couples presenting with infertility , AMH in IVF
Azoospermia is defined as the absence of spermatozoa in the ejaculate or simply absence of sperms in semen. Azoospermia accounts for about one fifth of all cases of male infertility and in 10-20 % of abnormal Semen Reports.
Role of decreased androgens in the ovarian response to stimulation in older women
Part I: Effects of testosterone (T) on preantral and antral follicles
Part II: How to improve ovarian response ?
Exogenous testosterone
DHEA
Aromatase inhibition (AI)
LH/HCG
Growth hormone (GH) / IGF-I
Role Of AMH In Infertility , Dr. Sharda Jain , Life Care Centre Lifecare Centre
Role Of AMH In Infertility , Advantage of AMH , Fecundity / Infertility & AMH , Infertility and AMH ,Prediction of pregnancy chances in couples presenting with infertility , AMH in IVF
Azoospermia is defined as the absence of spermatozoa in the ejaculate or simply absence of sperms in semen. Azoospermia accounts for about one fifth of all cases of male infertility and in 10-20 % of abnormal Semen Reports.
Role of decreased androgens in the ovarian response to stimulation in older women
Part I: Effects of testosterone (T) on preantral and antral follicles
Part II: How to improve ovarian response ?
Exogenous testosterone
DHEA
Aromatase inhibition (AI)
LH/HCG
Growth hormone (GH) / IGF-I
presentation on infertility, causes and its management. it gives an idea of the scope of the problem especially in sub Saharan Africa . the challenges in its management.
Optimal protocols for Ovulation induction (Assisted Reproductive technologies)Anu Test Tube Baby Centre
Presentation given in Tirupati, India in 2018 on Ovulation Induction for assisted reproductive technologies. Dealing with infertility using Intra uterine insemination (IUI) and In vitro fertilization (IVF)
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
IVF Center in Pune - A Complete Infertility SolutionIVF Treatment
For both women and men, aging, excessive exercise, diabetes, eating disorders, excessive alcohol consumption, smoking, environmental toxins, cancer treatments, sexually transmitted diseases (STDs), stress, obesity, and being underweight all contribute to infertility.
If you and your partner have been trying to conceive for more than a year after having unprotected sex but have been unsuccessful, it means that you or your partner or both are infertile. Infertility never stops you from being a parent. You can become a parent when you visit the best IVF center in Pune.
Let's see how you can become a parent after consulting the doctor at the IVF clinic. But first, we must understand what causes infertility and how to avoid it to be fertile.
For Women:
• Abnormal Periods
• Fallopian tube obstruction
• Damage fallopian tube
• Celiac disease
• Kidney disease
• Ectopic pregnancy
• Cysts in the ovaries
• Sickle cell disease
• Endometriosis
• Uterine fibroids
• Uterine Polyps
• Thyroid disorder
• Pituitary gland dysfunction
• Inflammation
• Ovarian insufficiency
• Polycystic ovary syndrome (PCOS)
For Men:
• Enlarged veins in the scrotum
• Cystic fibrosis (CF)
• Low sperm count.
• Testicular Injury
• Premature ejaculation
• Low testosterone levels
• Anabolic steroid overuse
• Ejaculation in reverse
• Cancer of the testicles
• Heat exposure to testicles
How Can I Avoid Infertility Forever?
• Consume a well-balanced diet
• Maintain physical activity
• Don't use drugs.
• Avoid smoking
• Limit alcohol.
• Get checked for STDs.
• Toxin exposure should be limited.
• Don't overdo exercise.
• Keep a healthy weight
Women's Infertility Diagnosis Process:
For Women:
• Body temperature
• Pelvic examination
• Blood test
• Hysteroscopy
• Laparoscopy
• Ultrasound transvaginal
• Hysterosalpingogram (HSG)
• Saline sonohysterography (SIS)
For Men:
• Analysis of sperm
• Blood test
• Scrotal Ultrasound
Infertility Treatment Process for Female:
Fertility Medication - fertility medication that helps to stimulate ovulation.
Surgery - Surgery is only applicable to remove uterine fibroids and uterine polyps, treat endometriosis, and open blocked fallopian tubes.
Related blog: A Detailed Guide to Female Infertility
Infertility Treatment Process for Male:
Fertility Medications - used to treat erectile dysfunction and improve hormone levels.
Surgery - Surgery can help to improve the health of sperm.
Related blog: A Detailed Guide to Male Infertility
The right time to take fertility treatment:
According to a survey, after the age of 35, the chances of increasing fertility begin to decrease and both men and women are recommended to talk to a fertility specialist to improve body function along with positive lifestyle changes.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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!
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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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. OUR ROLE
GIVE HER MENTAL SUPPORT
FIND THE CAUSE OF HER PROBLEM
FIND A WAY TO CORRECT IT
EDUCATE HER ABOUT THERAPY
DISCUSS ALTERNATIVES
4.
5. • In old days, WOMEN WERE BLAMED when
couples did not have children
• Disorders in Men in 20-30 PERCENT OF CASES,
disorders in women in 40-55 PERCENT OF CASES,
and disorders of both in 10-40 percent.
• Severe psychological stress
• Self-blame
• Marital disharmony or emotional conflicts
• Complicated with hormone therapy
• Cost
8. INDICATIONS FOR EVALUATION
• Evaluation should be offered to all couples who have FAILED TO CONCEIVE
AFTER A YEAR OR MORE OF REGULAR UNPROTECTED
INTERCOURSE, but a year of infertility is not a prerequisite for evaluation.
• Earlier evaluation is justified for:
➢ Women with irregular or infrequent menses
➢ H/O pelvic infection or endometriosis
➢ Male partner with known or suspected poor semen quality
• 6 MONTHS OF UNSUCCESSFUL EFFORT IN WOMEN > 35 YEARS
9. INITIAL ASSESSMENT
• BOTH PARTNERS SHOULD BE PRESENT
• Complete medical, surgical and gynecological history of the women should be
obtained.
• Risk factors to be evaluated.
• Physical examination of the women.
• Basic investigations mandatory before start of treatment.
10. • Hormones to regularize cycles, drugs for ovulation induction
• Symptoms of PID, STI
• Genital TB
• Hyper/hypo Thyroid, DM
• PCOD
• Previous abdominal or pelvic surgery
• Previous pregnancy, abortion
GENERAL HISTORY
14. • Frequency of intercourse
• Vaginismus
• Knowledge of fertile period and ovulation
COITAL HISTORY
15.
16. • Previous pregnancy – Spontaneous or
after treatment for infertility
• Abortion
• Ectopic pregnancy
• Puerperal sepsis
OBSTETRIC HISTORY
17.
18. • Height, Weight and BMI
• Thyroid enlargement, nodule or tenderness
• Breast secretion and their character
• Signs of androgen excess
• Pelvic or abdominal tenderness
• Vaginal or cervical abnormality, secretions or discharge
• Mass, tenderness or nodularity in the adnexa or cul-de-sac
PHYSICAL EXAMINATION
19. Infertility one year or
longer
Initial evaluation, history,
physical exam
Irregular menses
No ovul. by tests
HSG -
Tubal block
Anovulatory Tubal factors
Normal tests
Unexplained
infertility
HSG -
Anomaly of cavity
Uterine factor
Abnormal semen
analysis
Male factor
Counselling and Psychosocial support
If multiple factors present, investigate and manage concurrently
20. ANOVULATION
Normal or high day 3 FSH
and LH
Ovarian disorders
Low FSH, LH and E2 Abnormal TSH or T4 High sProlactin levels
Low LH, FSH, TSH, GH,
ACTH
Hypothalamic Disorders Thyroid disease Hyperprolactinemia Panhypopituitarism
Anorexia Hypothyroidism MRI Brain Assess and treat condition
Hypogonadotropic
Hypogonadism
Hyperthyroidism Pituitary microadenoma
Other abnormal brain
masses
Ovulation induction –
GnRH
Ovulation induction – FSH
I.U. / Timed intercourse
Treat underlying cause
21. OVARIAN DISEASES
Infrequent menses
Dec. estrogenization
High FSH, LH
Day 3 FSH
AMH
Advanced age
S&S of:
Hyperandrogenism
Oligomenorrhoea/ano
vulation
Premature ovarian
failure
Decreased ovarian
reserve
PCOD
Usually irreversible
Increased age –
decreased egg quality
Low chances of
treatment success
Increased risk of
aneuploidy
Ovulation induction
ART
IVF – Donor egg
Discuss adoption
IVF or I.U.I
Medical management
Surgical Management
22. RULE OF 4
• 4 punctures to be made on each
ovary
• 4 millimetre in diameter
• 40 watt current
• 4 seconds
23. OVULATION INDUCTION
• Infertility due to anovulation
• Necessary to exclude important pathologies before induction
and to identify successful form of treatment
• INITIAL EVALUVATION:
• IGT (35%)
• Semen analysis (20-40%)
• HSG / TVS
24. CLOMIPHENE CITRATE
• Non-Steroidal triphenyl ethylene derivative
• Acts as a SERM
• Both estrogen agonist and antagonist action
• Two stereoisomers : ENCLOMIPHENE and
ZUCLOMIPHENE
• MOA: Compete with the endogenous estrogen for the nuclear
receptors –> Inhibits the feedback on the hypothalamus –>
Increases GnRH pulse –> Increased ovulation
25. INDICATIONS
• DOC for ovulation induction in ANOVULATORY
INFERTILE WOMEN
• INEFFECTIVE in Women with Hypogonadotropic
hypogonadism
• Effective in Short Luteal Phase
• Empiric clomiphene treatment is most effective with I.U.I.
26. TREATMENT REGIMEN
• Started on 2nd to 5th day after onset of spontaneous or
progestin-induced menses
• 50mg tablet daily for 5-day interval – 52% success (FDA
approved)
• Max dose – 150mg daily
• Lower dose (12.5 – 25mg) – highly sensitive women
27.
28. MONITORING OF CLOMIPHENE ACTIVITY
• Serial Transvaginal Ultrasound
• Serum progesterone concentration
• Midcycle urinary LH surge
29. SIDE EFFECTS
• Palinopsia, Scotoma
• Transient hot flashes
• Mood swings
• Headache
• Breast tenderness
• Nausea
30. RISKS
• Multiple pregnancy (7-10%)
• No risk of birth defects
• Ovarian hyperstimulation syndrome (OHSS)
32. GONADOTROPINS
• Used in CLOMIPHENE RESISTANT cases
• hMG ( Human menopausal gonadotropin ) – contains both FSH and LH
• Recombinant FSH – only FSH activity
• Dose : 50 – 75 mIU/ml of FSH, given I.M. on day 5 of cycle
• TVS monitoring
• STEP UP REGIMEN is followed
33. AROMATASE INHIBITORS
• Inhibits enzyme AROMATASE, the enzyme which catalyzes the rate-
limiting step in estrogen production.
• Commonly used : ANASTRAZOLE and LETROZOLE
• MOA : Inhibits the peripheral conversion of testosterone to estrogen
causing a fall in the estrogen levels --> Increase in FSH levels -->
Ovulation --> Increased production of estrogen by follicle --> Negative
feedback --> Growth of dominant follicle
• NOT FDA APPROVED
34. TREATMENT REGIMEN
• Letrozole (2.5 – 7.5 mg daily) and Anastrazole (1mg) – 5 day interval
• Higher pregnancy rates when compared to clomiphene citrate (17.4% vs
12.4%)
35. RESULTS OF TREATMENT WITH AROMATASE
INHIBITOR
• EFFECTIVE IN CLOMIPHENE RESISTANT CASES
• Trials show that 75% anovulatory clomiphene-resistant women and 50%
women with PCOS ovulated following letrozole.
36. GnRH ANTAGONIST
• PULSATILE GnRH – TOC for HYPOGONADOTROPIC
HYPOGONADISM
• MOA: Blocks the GnRH receptors in pituitary gland
• PREVENTS PREMATURE LH SURGE and thus premature endogenous
ovulation in patients undergoing exogenous stimulation with FSH in preparation
for IVF.
• I.M. or S.C.
• Available preparations : CETRORELIX, GANIRELIX
• Risk of hyperstimulation is less compared to hMG
42. • Clinical Gynecologic Endocrinology and Infertility – Speroff 8E
• Berek & Novak’s Gynecology 15E
• Undergraduates Manual for Clinical Cases in Obstetrics and
Gynaecology
• Shaw’s Textbook of Gynaecology 15E
• NICE Guidelines – Fertility problems: assessment and treatment
• Kaplan & Sadock’s Synopsis of Psychiatry – 11E
REFERENCES
43. If it seems slow in coming,
wait patiently,
For it will surely take place.
It will not
be denied.
