This document summarizes a panel discussion on the management of IVF pregnancies conducted by Delhi ISAR, Advance Fertility and Gynaecology Centre, and Madhukar Rainbow Group of Hospitals. The panelists provided expert opinions on topics like the choice of ART treatment, number of embryos to transfer, luteal phase support, anomaly screening, reduction of higher order multiples, antenatal follow-up, prevention of preterm labor, use of antenatal steroids, and delivery timing in twin pregnancies. The document emphasizes that IVF pregnancies require special care and management.
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
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
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
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
prophylactic encerclage for multiple pregnancy is always debated.in this presentation cerclage for MFG is favored as there was a debate in recently held KSOGA conference at manipal on 3-11-11.
Multiple births—the delivery of twins, triplets, or more—is common with fertility treatments. During the use of assisted reproductive technology (ART)—such as in vitro fertilization (IVF)—multiple births primarily result from transfer of more than one embryo during the procedure
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
prophylactic encerclage for multiple pregnancy is always debated.in this presentation cerclage for MFG is favored as there was a debate in recently held KSOGA conference at manipal on 3-11-11.
Multiple births—the delivery of twins, triplets, or more—is common with fertility treatments. During the use of assisted reproductive technology (ART)—such as in vitro fertilization (IVF)—multiple births primarily result from transfer of more than one embryo during the procedure
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The day 3 embryo versus day 5 embryo transfer is a debate that has always persisted and here we attempt to present relevant data to assist in making a decision #day3embryo #day5embryo #ivf #icsi #embryotransfer #bestembryo #ivfsuccess #pgt #pgd #preimplantationgenetictesting #embryo #day3versusday5embryo
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
Strategies for improving success in Poor respondersKaberi Banerjee
Overcoming challenges associated with poor ovarian response is a critical aspect of in vitro fertilization (IVF) for individuals classified as poor responders. Various strategies can be employed to enhance the chances of success in this particular group of patients.
Firstly, individualized ovarian stimulation protocols play a crucial role. Tailoring medication dosages and adjusting the type of gonadotropins used based on the patient's age, ovarian reserve, and response to previous stimulation cycles is essential. Utilizing personalized approaches can optimize follicular development and improve egg yield.
Co-administration of adjuvant medications is another effective strategy. Growth hormone supplementation has shown promise in enhancing ovarian response and improving the quality of eggs in poor responders. Additionally, androgen pre-treatment has been explored as a means to improve ovarian function and response to stimulation.
Advancements in laboratory techniques, such as the use of time-lapse imaging systems, can aid in the selection of the most viable embryos for transfer. This ensures that the highest-quality embryos are chosen, increasing the chances of successful implantation.
Embryo transfer techniques also play a significant role in optimizing success for poor responders. Employing the assisted hatching technique or using preimplantation genetic testing (PGT) to screen embryos for chromosomal abnormalities can improve implantation rates.
In some cases, considering alternative approaches such as natural cycle IVF or minimal stimulation IVF may be beneficial for poor responders. These protocols aim to work with the patient's natural cycle or use lower doses of medications to reduce the risk of overstimulation and improve egg quality.
Furthermore, addressing lifestyle factors that may impact fertility, such as nutrition, stress management, and adequate sleep, is crucial for optimizing outcomes in poor responders.
In conclusion, a multifaceted approach is essential for improving success in poor responders undergoing IVF. By customizing ovarian stimulation protocols, incorporating adjuvant medications, leveraging advanced laboratory techniques, optimizing embryo transfer, and considering alternative protocols, fertility specialists can enhance the chances of a positive outcome for individuals facing the challenge of poor ovarian response.
Embryo Transfer- Tips and Tricks to improve successKaberi Banerjee
Improving embryo transfer technique is crucial in the field of assisted reproductive technology (ART) as it significantly influences the success of in vitro fertilization (IVF) procedures. A well-executed embryo transfer is vital for the optimal implantation of embryos, leading to a higher likelihood of a successful pregnancy. Here are several key strategies to enhance the embryo transfer technique:
Firstly, proper training and skill development for the fertility specialist or clinician performing the procedure are essential. Training programs that emphasize hands-on experience and guidance from experienced practitioners contribute to proficiency in embryo transfer. Continuous professional development ensures that practitioners stay updated on the latest advancements in the field.
Secondly, utilizing ultrasound guidance during embryo transfer enhances precision. Real-time visualization enables the clinician to accurately navigate the catheter through the cervix and deposit the embryos in the ideal location within the uterine cavity. This minimizes the risk of trauma and increases the chances of successful implantation.
Maintaining a relaxed and comfortable environment during the procedure is equally important. Studies suggest that minimizing stress and anxiety in both the patient and the clinician can positively impact the success of embryo transfer. This involves effective communication with the patient, addressing any concerns, and ensuring a supportive atmosphere in the clinic.
Optimizing the timing of embryo transfer concerning the woman's menstrual cycle is another critical factor. Synchronization between the embryo's developmental stage and the endometrial receptivity is vital. Personalized protocols and careful monitoring of hormonal levels contribute to better timing, enhancing the chances of successful implantation.
Lastly, considering individualized patient factors, such as uterine anatomy and the woman's overall health, is essential. Tailoring the embryo transfer technique to the specific needs of each patient increases the likelihood of a positive outcome.
In conclusion, continuous education, technological advancements, personalized approaches, and a patient-centered focus are key elements in improving the embryo transfer technique. Implementing these strategies can contribute to higher success rates in IVF procedures, bringing hope to individuals and couples seeking to build their families through assisted reproductive technologies.
The thin endometrium refers to the lining of the uterus, known as the endometrium, being insufficiently thick. This condition is typically characterized by a reduced thickness of the endometrial layer, which plays a crucial role in supporting the implantation and development of a fertilized egg during the menstrual cycle.
A thin endometrium is commonly associated with hormonal imbalances, such as low estrogen levels, which are vital for the growth and maintenance of the endometrial tissue. Inadequate blood flow to the uterus, chronic inflammation, or certain medical conditions can also contribute to this condition. Women with a thin endometrium may experience difficulties in achieving and maintaining pregnancy, as the thin lining may not provide an optimal environment for the embryo to implant and thrive.
Addressing the underlying causes of a thin endometrium often involves hormonal therapies to regulate estrogen levels, lifestyle modifications, and sometimes surgical interventions. Fertility treatments, such as in vitro fertilization (IVF), may be considered to overcome the challenges associated with a thin endometrium.
In conclusion, a thin endometrium can pose challenges to fertility and reproductive health, requiring a comprehensive approach to address the underlying factors and improve the chances of successful conception.
Preimplantation Genetic Testing - Dr Kaberi BanerjeeKaberi Banerjee
Preimplantation Genetic Testing for Aneuploidy (PGT-A), formerly known as preimplantation genetic screening (PGS), is a technique used during in vitro fertilization (IVF) to screen embryos for chromosomal abnormalities before implantation. Like any medical procedure, PGT-A has both advantages and disadvantages.
Pros of PGT-A:
Reduced Risk of Aneuploidy: PGT-A helps identify embryos with chromosomal abnormalities, such as aneuploidy, which can reduce the risk of implantation failure, miscarriage, and certain genetic disorders.
Improved IVF Success Rates: By selecting embryos with the correct number of chromosomes, PGT-A can enhance the chances of a successful implantation and a healthy pregnancy, leading to improved overall IVF success rates.
Reduced Miscarriage Rates: Identifying and transferring embryos with the correct chromosomal makeup may decrease the likelihood of spontaneous miscarriages, particularly in older women who are at a higher risk of producing embryos with chromosomal abnormalities.
Family Planning for Genetic Disorders: PGT-A allows couples at risk of transmitting specific genetic disorders to screen embryos for these conditions, enabling them to make informed decisions about which embryos to implant.
Cons of PGT-A:
No Guarantee of Pregnancy: PGT-A does not guarantee a successful pregnancy. Other factors, such as uterine receptivity, can still impact the success of embryo implantation.
False Positives and Negatives: PGT-A is not foolproof, and false positives and negatives can occur. In some cases, embryos identified as abnormal may be viable, leading to the potential discarding of healthy embryos, or vice versa.
Invasive Nature: The procedure involves removing a small number of cells from the developing embryo, which some argue could potentially harm the embryo, although the impact is generally considered minimal.
Financial Cost: PGT-A adds an additional cost to the already expensive IVF process. The financial burden may be a significant consideration for some couples, especially if insurance does not cover the expense.
Limited Scope: PGT-A primarily screens for numerical chromosomal abnormalities and may not detect all genetic disorders or structural chromosomal abnormalities. Additional testing, such as preimplantation genetic testing for monogenic disorders (PGT-M) or preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR), may be necessary for a more comprehensive assessment.
In summary, while PGT-A offers potential benefits in terms of reducing the risk of aneuploidy and improving IVF success rates, it is essential for couples to weigh these advantages against the potential drawbacks and consider their individual circumstances, including the financial and emotional aspects of the procedure.
Endometrial Receptivity Array- Dr Kaberi BanerjeeKaberi Banerjee
The endometrial receptivity array (ERA) is a diagnostic tool used in assisted reproductive technology (ART) to assess the receptivity of the endometrium, or the lining of the uterus, during the implantation window. While ERA has shown promise in improving the chances of successful embryo implantation, it also comes with its own set of advantages and disadvantages.
Pros of Endometrial Receptivity Array (ERA):
Personalized Timing: ERA helps determine the optimal window of endometrial receptivity for a specific woman. This personalized approach aims to synchronize the embryo transfer with the most favorable conditions for implantation, potentially improving the chances of successful pregnancy.
Reduced Pregnancy Loss: By accurately identifying the receptive window, ERA may contribute to reducing the risk of implantation failure and early pregnancy loss, especially in cases where previous IVF cycles were unsuccessful.
Improved Treatment Precision: ERA provides a more precise understanding of the individual's endometrial cycle, allowing fertility specialists to tailor the timing of embryo transfer to maximize the likelihood of success. This personalized approach may be particularly beneficial for women with irregular menstrual cycles.
Enhanced Cost-Efficiency: While the initial cost of an ERA test is an additional expense in the IVF process, the potential for increased success rates and reduced need for repeated embryo transfers may lead to cost savings in the long run.
Cons of Endometrial Receptivity Array (ERA):
Limited Evidence: Some critics argue that there is limited conclusive evidence supporting the routine use of ERA in all IVF cycles. The effectiveness of ERA is still a topic of ongoing research, and its widespread adoption may require more comprehensive validation.
Additional Cost: The ERA test adds an extra cost to the already expensive IVF process. Some couples may find it financially burdensome, especially if insurance coverage does not include this diagnostic procedure.
Invasive Nature: The endometrial biopsy required for the ERA test is an invasive procedure that may cause discomfort and pose a slight risk of infection or bleeding. However, the risks are generally minimal.
Time Consumption: The time required for the ERA test may extend the overall duration of the IVF process, which can be a concern for couples seeking a more expedited fertility treatment.
In conclusion, while the endometrial receptivity array offers potential benefits in improving IVF success rates through personalized timing, its adoption should be carefully considered based on individual circumstances, including financial considerations and the need for further research on its long-term efficacy.
Single embryo transfer (SET) is a reproductive technique employed during in vitro fertilization (IVF) that involves transferring only one embryo into the uterus. This approach has both advantages and disadvantages, influencing the decision-making process for couples and fertility specialists.
Pros of Single Embryo Transfer (SET):
Reduced Multiple Births: One of the primary benefits of SET is the significant reduction in the occurrence of multiple pregnancies, such as twins or triplets. Multiple pregnancies are associated with higher risks for both the mother and the babies, including preterm birth and low birth weight.
Enhanced Pregnancy Success Rates: Focusing on transferring a single embryo allows for better control and optimization of the conditions for implantation. This can result in higher success rates per transfer, increasing the likelihood of a healthy pregnancy.
Lower Risk of Complications: Single embryo transfers minimize the risk of complications associated with multiple pregnancies, such as gestational diabetes, preeclampsia, and cesarean section. This can lead to better maternal and neonatal outcomes.
Cost Savings: Although the initial cost of IVF is not necessarily reduced with SET, the long-term costs associated with caring for multiple preterm infants and potential complications are significantly lower.
Cons of Single Embryo Transfer (SET):
Lower Pregnancy Rates per Cycle: While SET can result in higher success rates per transfer, the overall pregnancy rates per IVF cycle may be lower compared to transferring multiple embryos. This can be a concern for couples with limited resources or time.
Potential Need for Multiple IVF Cycles: Achieving pregnancy with SET may require multiple IVF cycles, extending the time and financial investment for couples trying to conceive.
Emotional Stress: The uncertainty of success with each cycle can contribute to emotional stress for couples undergoing fertility treatments, particularly if they experience multiple unsuccessful attempts.
Age-Related Factors: For older women with diminished ovarian reserve, transferring a single embryo may further reduce the chances of success. In such cases, the decision to transfer multiple embryos may be considered based on individual circumstances.
In conclusion, the choice between single and multiple embryo transfer in IVF involves weighing the potential benefits of a healthy, singleton pregnancy against the desire for higher success rates and faster conception, considering the unique circumstances of each couple.
Chronic endometritis and its effect on FertilityKaberi Banerjee
Chronic endometritis, inflammation of the endometrial lining, may hinder fertility by disrupting the implantation process. Early diagnosis and treatment are crucial for optimizing reproductive outcomes and addressing infertility challenges.
"Embryo Transfer Strategies: Cleavage vs. Blastocyst"
Brief overview of the significance of embryo transfer in assisted reproductive technologies (ART) and the focus on cleavage and blastocyst stages with their merits and demerits.
"Transforming Reproductive Medicine with AI"
Brief overview of the impact of AI on various fields, leading into its applications in reproductive medicine.
A failed IVF cycle can be because of poor egg quality, sperm quality or uterine lining. It is assumed that all the stimulation egg pick up, laboratory procedures and embryo transfers have been done meticulously in previous attempts. We offer certain modifications in an IVF cycles for optimizing outcome in couples suffering from failed IVF attempts-
Optimized stimulation protocol: The short antagonist protocol offers the best results in terms of selection of the best oocytes (eggs) in most cases.
Selection of Sperm: In many cases, Intra Cytoplasmic Sperm Injection (ICSI) is offered as it has been suggested that it may improve fertilization rates and hence, overall pregnancy outcome. Our embryologist takes special care to select the best sperms for doing ICSI.
Hysteroscopy: The hysteroscope aids us in picking up uterine abnormalities which are sometimes missed at routine ultrasound e.g., small polyps. It is also useful in washing and cleaning the uterus which sometimes may help in improving the outcomes. Endometrial scratching is also done at the same setting to improve the uterine receptivity.
Intravenous Immunoglobulin (IYIg): IVIg seems to directly affect NK cell level and activity, by reducing their absolute numbers and increasing the expression of inhibitory receptors CD94 which potentially can improve pregnancy outcome.
Vitamins and Antioxidants: DHEA, L Arginine, Zinc, selenium etc. are given to women and men as indicated to improve the egg and sperm quality.
Atosiban: This is a uterine relaxant which is given during the embryo transfer. It helps in relaxing the uterus and therefore, improving the endometrial receptivity.
Laser Hatching: Laser hatching of the embryos is performed on the day of embryo transfer to ensure that the shell of the embryo hatches easily. This allows the embryo to implant better. This is mainly suitable for embryos with thick shell, advanced age group and frozen embryos.
ERA: ERA presumably detects the phase of the endometrium in which the embryo best implant. However, there is controversy regarding the actual benefit of this in improving the live birth rate.
PGS: PGS is a way of detecting abnormal embryos thus may help in improving the pregnancy rates. However, each case must be individualized.
Day of Transfer: Not all women will be benefitted by Blastocyst (Day 5 ) transfer as many seem to believe by studying the internet. The day of transfer should be individualized for each patient.
Meticulous Transfer Technique: Embryo transfer is the final and one of the most crucial step of IVF. All embryo transfers at AFGC are performed by Dr Kaberi Banerjee who has taken special training in embryo transfer from UK.
Preimplantation Genetic Diagnosis (PGD)/Screening (PGS) With IVFKaberi Banerjee
Pre-implantation genetic Screening (PGS) or Pre-implantation genetic diagnosis (PGD) plays an important role in increasing the chances of pregnancy for infertile couples.
Preimplantation genetic diagnosis (PGD) is a procedure used to diagnose embryos for known genetic disorders that both the patients and partners.
Read more: https://www.advancefertility.in/preimplantation-genetic-diagnosis-pgd-pgs-with-ivf/
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
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
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
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
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
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 Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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!
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.
2. Dear Friends
Greetings!
It gives us immense pleasure to compile the panel discussion on IVF
pregnancies which was conducted on the 12th
May 2019 along with
Delhi ISAR, Advance Fertility and Gynaecology Centre, and
Madhukar Rainbow Group of Hospitals.
We sincerely thanks Dr. Atul Chopra, Dr.Naveen Gupta, Dr.Gaurav
Java, Dr.Maju Hotchandani, Dr.Meenakshi Ahuja, Dr.Sadhana
Kala , Dr.Shelly Singh, Dr.Chanchal and Dr.Neena Behl for all
their expert opinion as esteemed panelists.
We hope you find this document on ‘Management of IVF
Pregnancies’ useful.
Sincerely,
Dr. Kaberi Banerjee Dr. Jayasree
Sundar
Medical Director Director, Obs & Gyn.
Advance Fertility & Gynaecology Centre Madhukar Rainbow Child
Chairperson, Delhi- ISAR Hospital, New Delhi
3. Choice of ART Treatment
Q1. A young couple is unsuccessfully trying to conceive from the
past 5 months.In which patient would you suggest ART and in
whom will you advice to conceive normally.
a. Young couples who are trying to conceive for less than two years and
in whom all other parameters (hormonal profile, TVS, tubal patency and
semen analysis) are normal can wait and continue trying naturally.
However women with bilateral tubal damage, ovarian failure and poor
endometrium will need IVF/third party reproduction soon rather than
later. Men with poor sperm count or azoospermia will need IVF/ICSI
with or without TESA.
Since the results of fertility treatment are age dependent any woman who
has received unsuccessful treatment for more than 3 years or who is
more than 35years of age should avail soon rather than later.
4. Number of Embryos to transfer
Q2.A 28yr.old lady married for 5yrs with primary infertility and bilateral
tubal block undergoes IVF.10 eggs are retrieved, 7 get fertilized and 6 good
quality embryos are transferred. How many embryos will you transfer?What
is your opinion about single embryo transfer?
The Following table shows the number of embryos that can be transferred
according to NICE guidelines
The ASRM( in April 2012) society recommends-
The Utilization of eSET has increased over the past decades in the U.S. Use Of ET
has also increased but the twining rate has remained the same. eSET is most
appropriate for those with the good prognosis.
Elective SET is most appropriate for those with the good prognosis age <35 years
more than one quality embryo available for transfer, first or second treatment
cycle, previous successful IVF and recipients of embryos from donated
eggs.Women aged 35-40 years may be considered for eSET if they have top
quality blastocyst-stage embryos available for transfer.Decisions regarding eSET
of cryopreserved embryos should take into consideration prognosis, embryo
quality and success rates of the individual cryopreservation program. Challenges to
increased use of eSET exists. These include provider and patient education,
financial consideration, embryo selection and successful cryopreservation .Stake
holders should recognize that the optimal outcome of an IVF cycle is the birth of
the healthy singleton.Reduced financial burdens for IVF through insurance
5. coverage or risk sharing programs have been shown to improve patient acceptance
of eSET.Selection and successful cryopreservation of the embryos with the highest
IRs(implantation rates) will facilitate wider use of eSET.
De Sutter at all in an original paper title ‘Does three or more embryos make sense
for a well defined population of infertility patients undergoing IVF/ICSI/?’In
obstetrics and gynecology general in 2012 discuss the need to transfer more
number of embryos in a select group of patients. Table 1 describes the Belgian
policy.
The paper analyzed the relation between the probability of outcome and the
number of embryos transferred.
The paper then suggests a clinical protocol where HLT (more than three
embryos)will be a good option.
6. The paper suggests that HLT can be considered for the poor prognosis group of
women. Limiting the number of embryos to transfer to a maximum of two in all
cases probably leads to under treatment of this subpopulation.
Facts Views Vis Obgyn. 2012;4(1):51-518
In India IVF is an uninsured medical process. Patients pay out of their own pockets
and they usually come at an advance age for IVF. The ovarian reserve in South
Asian population is 2-3 yrs advance in Caucasian. Endometritis is also common.
Considering all these parameters transfer of two or more embryos may be justified
in certain situations.In the Indian scenario eSET can only be done in young good
prognosis patients and in labs having robust cryopreservation system.
7. Luteal Phase support in IVF Pregnancy
Q3. What is the recommended luteal phase support in first trimester in IVF
pregnancies?
a.Luteal phase support is needed in IVF pregnancies because during follicular
aspiration there is disruption of granulosa cells which leads to compromise corpus
luteum.Supra physiological concentration of steroids secreted by high number of
follicles also demands increase progesterone support .Progesterone can be taken in
oral, vaginal or intramuscular form.
Micronized progesterone can only be taken as vaginal, rectal or intra muscular
form. Recent studies have indicated that oral dydrogesterone is a viable alternate to
micronized progesterone .
Human Reproduction.2018,1;33(12):2212
HCG or progesterone given during the luteal phase may be associated with higher
rates of live birth or ongoing pregnancy than placebo or no treatment, but the
evidence is not conclusive. The addition of GnRH at o progesterone appears to
improve outcomes. hCG may increase the risk of OHSS compared to placebo.
Moreover hCG with or without progesterone, is associated with higher rates of
OHSS than progesterone alone. Neither the addition of estrogen nor the route of
progesterone administration appears to be associated with an improvement in
outcomes.
Cochrane DatabaseSyst Rev.2015 Jul 7;(7):CD009154
The addition of estrogen in Luteal phase is beneficial.
JBRA Assist Reprod.2017 Sep 1;21(31):247
Addition of other adjuvants like aspirin can be given in specific situation like
antiphospholipid antibody syndrome, thrombophilia and recurrant implantation
failures.
8. Anomaly Screening in IVF Pregnancies-Single Vs Multiple
Q4. Pregnancy has reached 12 weeks: what next?
i. First trimester screening – ultrasound (Down syndrome markers, early
anomaly scan, uterine artery Doppler) + serum biochemistry.
a. Combined screening (USG for NT/NB and dual marker) has the highest
detection rate for Down syndrome. Adding Placental growth factor (PlGF) to the
dual marker has the added advantage of screening women for the risk of
developing early preeclampsia/fetal growth restriction – early identification allows
starting low dose aspirin at the correct gestation.
ii. Any different in twins or higher order multiples?
a. Combined screening (USG + dual) has the best detection rate for twin pregnancy
as well.
b. MoMs need to be corrected for both IVF and chorionicity.
c. A single risk is assigned for monochorionic twin pregnancies.
d. Individual risks are calculated for each twin in dichorionic pregnancy.
e. No role of dual marker in higher order multiples.
f. Quadruple marker in twins has detection rate of only 56% and should be done
only when first trimester screening has been missed.
9. iii. Serum biochemistry in twins with one vanishing twin
a. If fetal pole and cardiac activity seen – treat as twin.If empty sac – treat as
singleton.
10. Reduction in Higher order Multiple Pregnancies
Q5. What should we do when we are faced with higher order multiple
pregnancy ?
i. Reduction versus expectant management
a.5-7% risk of procedure related miscarriage (per fetus reduced)
Obican S, et al, ClinObstet Gynecol. 2015
ii. Triplets with one monochorionic pair – whom to reduce?
a.Ideally reduce the monochorionic pair because of 10-15% risk of twin twin
transfusion syndrome (TTTS) and/or selective FGR (7% risk of miscarriage).
Interstitial laser if couple wants to have twins (10% risk of procedure related
miscarriage, another 50% risk of losing the cotwin after 2 weeks).
11. Antenatal Follow-up in Twins
Q6. How is Antenatal follow up in twins?
i. Monochorionic versus dichorionic
a.Monochorionic: 2 weekly ultrasound surveillance, delivery at 36-37 weeks.
Dichorionic: 4 weekly ultrasound surveillance, delivery at 37-38 weeks.
ii.Higher order multiples
Weekly ultrasound surveillance, delivery at 34-36 weeks.
iii.Role of bed rest
No role! Detrimental – increased risk of DVT and adverse outcomes. Restricted
activity may be advised.
12. Prevention of Pre-term Labor
Q7. Prevention of preterm labour in twin pregnancy?
i. Role of progesterone.
a. Though there are no robust randomized controlled trial (RCT) studies, most
studies have indicated the benefits of progesterone in IVF twin pregnancies.
BJOG. 2017 Jul;124(8):1163
On the basis of current knowledge, progesterone should be offered to women with
a documented history of a previous spontaneous birth at less than 37 weeks and for
those found to have a short cervical length of 15mm or less. Studies are needed to
evaluate progesterone efficacy on other risk factors.
Curr Opin Obstet Gynecol. 2009 Apr;21(2):142
ii. Role of routine cervical screening
a. Routine cervical length screening may reduce the risk of very preterm birth.
Journal of Obstetrics and Gynaecology. 2018 March 14;(38):789
ii.Role of prophylactic cerclage
Cerclage works in a carefully selected group of patients. Recent studies have
indicated that routine prophylactic cerclage even without shortening may be
beneficial.Ultrasound Obstet Gynecol.2016 Nov;48:752-756
iv. Role of antibiotics
a.The evidence supports not giving antibiotics routinely to women in preterm
labour with intact membranes in the absence of overt signs of infection. Further
research is required to develop sensitive markers opf subcilical infection for
women in preterm labour with intact membranes,as this is a group that might
benefit from future novel interventions, including new modalities of antibiotic
13. therapy.The results of this review demonstrate the need for future trials in the area
of preterm birth to include assessement of long-term neurodevelopmental outcome.
Cochrane Database Syst Rev. 2013 Dec 5;(12):CD000246
Role of Antenatal Steroids
Q8. Role of Antenatal steroids ?
i. Routine prophylaxis?
a. No benefit if >7 days elapse from steroid cover –
no role of routine prophylaxis
ii. At what gestation?
Anytime upto 34 weeks when preterm labour (iatrogenic or spontaneous)
Benefit proven even upto 36 weeks (ASTEROID trial) when preterm delivery.
Elective LSCS – upto 39 weeks
iii. Role of second (rescue) dose?
ACOG - if >2 weeks have elapsed and gestation is less than 34 weeks, one rescue
dose may be given.
iv. Which steroid and what dose? Dexa versus betamethasone
a.Dexa versus betamethasone
GOI 2014 – dexamethasone (beta salt AA, dexa less susceptible to heat)
14. v. Role of Tocolysis
Should be considered for steroid cover.
At Advance Fertility and Gynecology Centre ,New Delhi, Dr. Kaberi Banerjee
recommends prophylactic steroid cover at 26-28 weeks and repeat course at 30-32
weeks for all multiple pregnancies. This way early preterm delivery is covered.
None of the babies deliver with such a regimen of steroid cover required extended
neonatal ICU Care or surfactant treatment ,even in cases where delivery is at 30-32
weeks of gestation.
• Short acting
• 6 mg 12 hrly for 4 doses (total – 24 mg)
• Heat stable
• Available in India
Dexamethasone Na
Phosphate
• Short acting
• 4 mg 8 hrly for total of 6 doses (total – 24 mg)
• Heat stable
• Available in India
Betamethasone Na
phosphate (4 mg/ml
in betensol)
• Long acting
• 12 mg 24 hrly for total of 2 doses (total – 24
mg)
• Not heat stable
• Not Available in India
Betamethasone
Acetate + phosphate
(1 ml contains 3 mg
both)
15. Delivery in Twin Pregnancy
Q9. At what gestation should an IVF pregnancy be referred to a tertiary care
centre?
If high risk factors develop (either maternal or fetal), in utero transfer is better
than delivery and transferring the neonate.
Low threshold for transfer at gestations less than 34 weeks.
Q10. Multiple pregnancy: optimal time for delivery? Twins : Dichorionic
versus Monochorionic.
Timing of delivery-Dichorionic Twin Pregnancy
• Depends on chorionicity
• Uncomplicated dichorionic/diamniotic twin – 38 – 38+6 weeks
• Delivery at 37 to 37+6 wks is reasonable alternative
• Earlier if complicated by Intrauterine growth restriction
Obstet Gynecol. 2016;128(4):e131
Timing of delivery-Monochorionic Twin Pregnancy
• Diamniotic monochorionic
• Before 36+6 wks
BMJ. 2016;354:i4353
ACOG suggests
• Uncomplicated monochorionic – 34 – 37+6 wks
• If growth restricition – 32 to 34+6
Obstet Gynecol. 2016;128(4):e131.
• Monoamniotic monochorionic
• Delivery early in third trimester
16. TAKE HOME MESSAGE
• Select your patient group for ART carefully.
• Judgement the number of embryos to be transferred is multifactorial.
• Luteal phase support is helpful in first trimester.
• Addition of Adjuvants must be done on a case to case basis.
• Select your patient group for ART carefully.
• Judgement the number of embryos to be transferred is multifactorial.
• Luteal phase support is helpful in first trimester.
• Addition of Adjuvants must be done on a case to case basis.
• IVF Pregnancies do need special care.
• Prophylactic Steroids-There is role of prophylactic steroids and cerclage in IVF twin
pregnancies.
• Cerclage.
• In Utero Transfer of extremely premature babies well equipped neonatal I.C.U. is always
preferred.
• Role of good NICU cannot be over emphasis in handling IVF pregnancies.