Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION Dr. Sharda jain Lifecare...Lifecare Centre
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION DR. SHARDA JAIN , DR. JYOTI AGARWAL
DR. JYOTI BHASKAR
DEFINITION
Unexplained infertility means that couple does not conceive after 1year of unprotected vaginal sexual intercourse, with basic infertility evaluation showing no obvious abnormality.
INCIDENCE
15%to 20% of infertile couples
UNEXPLAINED IS PRIMARILY A
DIAGNOSIS OF EXCLUSION
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION Dr. Sharda jain Lifecare...Lifecare Centre
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION DR. SHARDA JAIN , DR. JYOTI AGARWAL
DR. JYOTI BHASKAR
DEFINITION
Unexplained infertility means that couple does not conceive after 1year of unprotected vaginal sexual intercourse, with basic infertility evaluation showing no obvious abnormality.
INCIDENCE
15%to 20% of infertile couples
UNEXPLAINED IS PRIMARILY A
DIAGNOSIS OF EXCLUSION
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
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
Female and male infertility Causes & Management by Asar KhanAsar Khan
In this Presentation we have included the male and female infertility their causes and Management. we hope that it will provide you some basic information regarding this issues.
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
all the informations taken from Sperrof 8th edition
all the informations are upto date
especially designed for MD MS student in Obstetrics and gynaecology doing their Residency
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Patient selection and work-up
Ovarian stimulation
Monitoring of follicular growth and endometrial development
Timing of insemination
Number of inseminations
Semen preparation
Insemination procedure
Luteal support
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
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
Female and male infertility Causes & Management by Asar KhanAsar Khan
In this Presentation we have included the male and female infertility their causes and Management. we hope that it will provide you some basic information regarding this issues.
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
all the informations taken from Sperrof 8th edition
all the informations are upto date
especially designed for MD MS student in Obstetrics and gynaecology doing their Residency
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Patient selection and work-up
Ovarian stimulation
Monitoring of follicular growth and endometrial development
Timing of insemination
Number of inseminations
Semen preparation
Insemination procedure
Luteal support
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
it describes in detail about causes, investigations and management of female infertility.in the end of presentation, it includes a video demonstration to describe the management options of assisted conception.
Introduction
Natural conception
Epidemiologic figures
Factors affect the natural conception rate
Causes of subfertility
Female causes of subfertility
ovulation
Ovarian problems
Marker of ovarian reserve
Tubal blockage
Endometrial factors
Uterine factors
Cervical factors
History and PE
Investigations
Treatment
Male subfertility
Hypothalamic-pituitary disease
Obesity
Primary hypogonadism
Sperm transport disorders
Defective ejaculation
History and PE
Investigations
Surgical sperm retrieval
Cryopreservation of gametes
As an intern doctor in Gyne department , this presentation outlines the steps of assessment of an infertile couple including history taking , examinations and relevant investigations and imagings .
Explore the intricacies of ovulation induction in intrauterine insemination (IUI) with Dr Laxmi Shrikhande's informative slide share presentation. From understanding the hormonal mechanisms to the latest techniques, this presentation offers insights into optimizing fertility through IUI. Whether you're a clinician seeking to enhance patient outcomes or an individual navigating fertility treatments, this resource provides valuable knowledge for your journey towards conception.
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.
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.
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
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. Introduction
Definition:
Infertility defined as a failure to conceive within one or more
years of regular unprotected intercourse.
The male is directly responsible in about 30-40 % of
infertility, the female in about 40-55 % and both are
responsible in about 10 percent cases. The remaining 10 % is
unexplained.
3
4. For management…
Counselling is very important and essential.
Routine examination is not necessary unless indicated by the
history.
History taking is important part in management to find out the
cause.
The management of the individual couple should always be
discussed in the context of their particular clinical situation.
Patients should be fully involved in decisions regarding their
treatment and always insist the couple to come together.
4
5. Classification
Primary infertility: Those patient who have never conceived.
Secondary infertility: It indicates previous pregnancy but
failed to conceive subsequently.
5
6. Category 1 Category 2
Young couples married
recently or not having
knowledge regarding fertile
period
Couples married more than 2 year
ago,
Age around 30 years
Particular female with mild male
factor
6
Category 3 Category 4
• Any age group but less than
35 years
• Previously diagnosed
condition like tubal block,
endometriosis, severe male
factor
• Old age couples
• Young female with premature
ovarian failure
• Severe uterine problems
9. Initial work up and diagnosis
Initial work up of an infertile couple should be very prompt
and perfect
Investigation should be logical and cost effective
9
10. Medical history(female)
History: Age ,duration of marriage, history of previous
marriage
General medical history: of STD, tuberculosis, PID, diabetes..
Surgical history: Abdominal or pelvic history may be related
to peritubal adhesion.
Menstrual history: Hypomenorrhea, oligomenorrhea to
amenorrhea are associated with disturbed hypothalamopituitary
ovarian axis which may be either primary or secondary to
adrenal or thyroid dysfunction.
10
11. Previous obstetric history: Number of pregnancies, interval
between them and related complication to be inquired. the
history of puerperal sepsis may be responsible for ascending
infection and tubal damage. Uterine synechie may be due to
vigorous curettage.
Contraceptive practice: IUCD use may cause PID
Sexual problems: Dyspareunia and loss of libido are to be
inquired
11
12. Medical history:(Male)
Genital tract infection : Mumps, orchitis, prostatitis
History of impotence, premature ejaculation, change in libido
Surgical history of testicular torsion, undescended or maldescended
testis, prostate surgery, hernia repair
Trauma: genital or inguinal region
Exposure to lead, cadmium, mercury
Drug history:
Sulphasalazine
Phenothiazine/antipsychotics/metoclopramide
Immunosuppressant/antineoplastic agents
12
15. Advice
Regular Sexual intercourse
Smoking reduces both, women’s fertility as well as semen quality
Excessive alcohol is detrimental to semen quality and may cause
erectile dysfunction
A body mass index of more than 29 is associated with reduced
fertility in both men and women
Folic acid supplement prior to conception and up to 12 weeks of
conception
Rubella immunity should be checked, if vaccinated then advise to
avoid pregnancy for at least one month after vaccination
15
16. Ovulatory dysfunction
Ovulatory dysfunction is a very common problem contributing 25-30
% causes of infertility and 50 % of female infertility
Normally ovulation requires coordination of central hypothalamic
pituitary axis, the feedback signals and local responses within the
ovary
Causes of anovulation
Central
Abnormal feedback
Metabolic
Local ovarian condition
General
16
17. Ovulation induction(OI)
OI is useful in patients with anovulatory infertility
WHO class I: Hypogonadotrophic hypogonadism
WHO class II: polycystic ovary syndrome (PCOS)
Goal
Stimulate development of a single follicle that will be able to reach
preovulatory size and rupture
Options
Clomiphene citrate (CC)
Gonadotropins (hMG/FSH followed hCG)
GnRH analogue
17
18. Clomiphene citrate(CC):
CC is an antiestrogen that binds to estrogen receptors and
interferes with estrogen-negative feedback
Results in an alteration in pulsatile GnRH secretion
Leads to increases in gonadotropin secretion and follicular
development
CC is widely used for ovulation induction in women with
PCOS and in couples with unexplained infertility
18
19. CC treatment successfully induces ovulation in about 80% of
properly selected candidates
Pregnancy rates are much lower (30%-40% per cycle)
40%-45% of couples can become pregnant within 6 cycles
Failure to conceive after successfully induced ovulation is
indication for further evaluation
Patient characteristics predictive of poor response to CC:
Hypothalamic disorder
Low estrogen levels
Obesity
19
20. CC is generally well tolerated, although some side effects may
limit its efficacy and safety
Short-term, reversible side effects include: hot flashes, mood
swings, visual disturbances, breast tenderness, pelvic
discomfort, and nausea
The anti estrogenic effects may negatively impact the uterine
lining, leading to lower pregnancy rates
Risk of multiple pregnancy is increased
20
21. Risk of cancer is increased among women who were treated
with CC
Uterine fibroid risk increases with CC treatment
Risk of ovarian cancer increases among women treated with
prolonged CC
Dose: 50 mg ,we can increase up to 250 mg but we give upto 150
mg per day due to antiestrogenic effect on endometrium
Start CC in a dose of 50 mg from day 2,3,4, or 5
Patient can either ovulate spontaneously or it can be triggered by
hCG when follicle size is 18-22 mm
21
22. Enclomiphene
It appears to have promising future in OI
Synthetic, non steroidal antiestrogen
First line treatment strategy in WHO class 2 anovulatory
infertility
It has centrally antiestrogenic effect for ovulation induction and
peripherally estrogenic action for endometrial thickening and
increased cervical discharge.
Dose: 50 mg daily for 5 days from day 2 of menstrual cycle
22
23. Aromatase inhibitors
Currently available drugs are Letrozole, Anastrozole,
Exemestane
M/A- Centrally it increases gonadotropin secretion and
stimulation of ovarian follicle, peripherally it increases
follicular sensitivity to FSH
Androgen accumulation in follicle stimulate IGF-1 promoting
folliculogenesis
Dose: 1 to 2 mg from day 3 of menstrual cycle daily for 5 days
23
24. Letrozole: it is banned due to its associated risk of congenital
cardiac and malformation in newborn.
Indication:
PCOS
CC resistant cases
Situation in which multiple pregnancy is not
desirable or risk of OHSS is high
24
25. Moderator/Regulator:
Myo-inositol(vitamin B8)
Phosphatidylinositol 3 kinase production and activation is essential
for insulin to act.
Myo-inositol has important role in production and activation of PI3
kinase improves insulin’s action and ensure ovulation
Dose: 2 gm twise a day for 16-20 weeks
Ovulation rate is around 60-70%
It reduces testosterone, decreases BMI and decreases hirsuitism.
Other combination: folic acid and vitamin D
25
26. Ovulation Induction:
Gonadotropin Treatment
Optimal for women who have failed CC or who cannot
risk waiting
Used in women with inadequate pituitary secretion of
LH and FSH (Hypogonadotrophic amenorrhea) or
PCOS
Agents: FSH, hCG, human menopausal gonadotropin
(hMG)
Success rates
WHO class I: 30% per cycle
WHO class II: 17% per cycle
May include IUI or natural intercourse
hCG
26
27. Controlled ovarian stimulation:
Gonadotropin treatment
Starts with higher dose of gonadotropins than for OI (COS:
150-225 IU of FSH; OI: 50-75 IU of FSH)
Needs GnRH analog treatment to prevent interference by
endogenous hormones
COS is followed by oocyte retrieval, IVF, and transfer of
embryos
hCG
27
30. OI = ovulation induction COS = controlled ovarian stimulation
IVF = in vitro fertilization IUI = intrauterine insemination
ICSI = Intracytoplasmic sperm injection.
30
31. Intrauterine insemination(IUI)
Indications
Unexplained infertility
Male subfertility—mild oligozoospermia, asthenozoospermia, or
teratozoospermia
Failure to conceive after ovulation induction treatment
Ejaculatory failure
Retrograde ejaculation
Procedure
Washed prepared sperm are deposited in the uterus just before the
release of an egg or eggs in a natural or stimulated cycle
Success rate: up to 15% per cycle
Significant risk for multiple pregnancy
31
32. In Vitro Fertilization
Procedure
Initially used in women with fallopian tube blockage or
damage
Now employed for many causes of infertility (eg.
Endometriosis, male factor)
Involves
COS
Egg retrieval
Insemination, fertilization, embryo culture
Embryo transfer
Cryopreservation of extra embryos
32
33. Risks
Ovarian hyperstimulation stimulation syndrome
Usually not serious and resolves with outpatient management
1%-2% severe requiring hospitalization
Dose-dependent, avoided by careful titration
Anesthesia
Multiple births
Ectopic pregnancy
Cost
Psychologic distress
33
34. Intracytoplasmic Sperm Injection
Indications
Very low numbers of motile sperm
Severe teratospermia
Problems with sperm binding to and penetrating the egg
Antisperm antibodies
Prior or repeated fertilization failure with standard IVF methods
Obstruction of the male reproductive tract not amenable to repair
34
35. Success Rate and Complications
Fertilization rate: 50%-80%
Live offspring: 20%-40% (40% in younger women, success
declines with maternal age)
35
36. References
1. Sushma D, editor. Infertility management made easy. 2nd ed. New
Delhi: Jaypee brothers medical publishers (p) LTD; 2014.
2. Keith LP, Bernard PS. Introduction To Endocrinology: The
Hypothalamic-Pituitary axis. Brunton LL, Goodman & Gilman’s
the pharmacological basis of therapeutics.11th Ed. Mcgraw-hill:
Medical Publishing Division;2006. P. 1117-24.
3. Dutta DC, Textbook of gynecology, 6th ed. New Delhi: Jaypee
brothers medical publishers (p) LTD; 2013.
36