2021 Gonadotropins for controlled ovarian hyperstimulationHesham Al-Inany
1) The document summarizes key findings from the MEGASET-HR trial which compared the use of HP-hMG versus rFSH alfa in ovarian stimulation for IVF/ICSI among high responders. 2) Key results showed no significant differences in ongoing pregnancy rates per cycle started between the two gonadotropins but HP-hMG was associated with fewer oocytes retrieved and lower estradiol levels. 3) Regarding safety, the rate of OHSS was similar between groups while the rate of early OHSS was slightly higher with HP-hMG.
This document provides an update on poor ovarian response and approaches to improving outcomes for women with poor ovarian reserve undergoing IVF treatment. The key points summarized are:
1) The PRIMA study found no difference in pregnancy outcomes between a mild ovarian stimulation protocol using 150 IU of FSH daily versus a conventional stimulation protocol using 450 IU of HMG daily for women with poor ovarian reserve, despite the mild protocol requiring fewer days of stimulation and lower gonadotropin doses.
2) While increasing gonadotropin doses does not improve pregnancy rates, supplementation with LH during stimulation may provide benefits for women with poor ovarian reserve based on prior studies.
3) A new approach called "dual stimulation"
Laura Baquedano Mainar discusses non-hormonal and non-herbal therapies for menopause symptoms. The document reviews evidence for the efficacy and safety of various options including:
1. Non-hormonal drugs like SSRIs, SNRIs, gabapentinoids which show mild-moderate improvement in hot flashes and night sweats but can have side effects.
2. Lifestyle modifications and diet changes like weight loss, exercise, and smoking cessation which may help reduce menopause symptoms.
3. Behavioral therapies like yoga, relaxation, and cognitive behavioral therapy have uncertain benefits for hot flashes though may improve sleep, mood, and stress.
4
This document provides guidelines for the use of electronic fetal monitoring (EFM) during labor and delivery. It was developed by a multidisciplinary group including representatives from several medical organizations and consumer groups. The guidelines aim to evaluate the impact of EFM, develop standards for its use, improve interpretation of EFM readings, and consider medico-legal and resource implications. The guidelines are based on a review and appraisal of available evidence on EFM.
1) Unexplained infertility poses challenges as Cochrane reviews find no difference in live birth rates between IUI and timed intercourse, yet anxious couples expect treatment.
2) Low cost ovarian stimulation with oral medications like clomiphene citrate or letrozole plus gonadotropins for IVF shows no difference in outcomes versus gonadotropins alone, but may increase cycle cancellations.
3) For thin endometrium (<7mm), studies of over 40,000 transfers find live birth rates decrease with thickness but may be 18-21% even at 5-5.9mm, providing reassurance for physicians and patients.
2021 Gonadotropins for controlled ovarian hyperstimulationHesham Al-Inany
1) The document summarizes key findings from the MEGASET-HR trial which compared the use of HP-hMG versus rFSH alfa in ovarian stimulation for IVF/ICSI among high responders. 2) Key results showed no significant differences in ongoing pregnancy rates per cycle started between the two gonadotropins but HP-hMG was associated with fewer oocytes retrieved and lower estradiol levels. 3) Regarding safety, the rate of OHSS was similar between groups while the rate of early OHSS was slightly higher with HP-hMG.
This document provides an update on poor ovarian response and approaches to improving outcomes for women with poor ovarian reserve undergoing IVF treatment. The key points summarized are:
1) The PRIMA study found no difference in pregnancy outcomes between a mild ovarian stimulation protocol using 150 IU of FSH daily versus a conventional stimulation protocol using 450 IU of HMG daily for women with poor ovarian reserve, despite the mild protocol requiring fewer days of stimulation and lower gonadotropin doses.
2) While increasing gonadotropin doses does not improve pregnancy rates, supplementation with LH during stimulation may provide benefits for women with poor ovarian reserve based on prior studies.
3) A new approach called "dual stimulation"
Laura Baquedano Mainar discusses non-hormonal and non-herbal therapies for menopause symptoms. The document reviews evidence for the efficacy and safety of various options including:
1. Non-hormonal drugs like SSRIs, SNRIs, gabapentinoids which show mild-moderate improvement in hot flashes and night sweats but can have side effects.
2. Lifestyle modifications and diet changes like weight loss, exercise, and smoking cessation which may help reduce menopause symptoms.
3. Behavioral therapies like yoga, relaxation, and cognitive behavioral therapy have uncertain benefits for hot flashes though may improve sleep, mood, and stress.
4
This document provides guidelines for the use of electronic fetal monitoring (EFM) during labor and delivery. It was developed by a multidisciplinary group including representatives from several medical organizations and consumer groups. The guidelines aim to evaluate the impact of EFM, develop standards for its use, improve interpretation of EFM readings, and consider medico-legal and resource implications. The guidelines are based on a review and appraisal of available evidence on EFM.
1) Unexplained infertility poses challenges as Cochrane reviews find no difference in live birth rates between IUI and timed intercourse, yet anxious couples expect treatment.
2) Low cost ovarian stimulation with oral medications like clomiphene citrate or letrozole plus gonadotropins for IVF shows no difference in outcomes versus gonadotropins alone, but may increase cycle cancellations.
3) For thin endometrium (<7mm), studies of over 40,000 transfers find live birth rates decrease with thickness but may be 18-21% even at 5-5.9mm, providing reassurance for physicians and patients.
Luteal Phase Support: Key Variables to Achieve Success in ARTSandro Esteves
This document discusses luteal phase support in assisted reproductive technology cycles. It covers:
1. The pathophysiology of the luteal phase defect in stimulated cycles and the role of progesterone supplementation.
2. Different luteal phase support protocols after hCG trigger in fresh embryo transfer cycles, including progesterone alone versus progesterone plus hCG or GnRH agonist.
3. Luteal phase support considerations for frozen embryo transfer cycles, including the type and timing of estrogen and progesterone administration.
Update (2021) Oral Contraceptive Pill : Dr. Jyoti Agarwal Dr Sharda Jain Lifecare Centre
Update (2021) Oral Contraceptive Pill : Dr Sharda Jain
7 Billion 2011 & increasing a rate of 150 million per year
INDIA
Today – 1.3 billion 2050 – 1.628 expected
This document provides guidance on cardiac disease and pregnancy. It notes that cardiac disease is a leading cause of maternal death in developed countries. The purpose is to summarize expert opinions to help plan management of affected pregnancies until more evidence is available. It discusses various types of cardiac conditions that pose risks in pregnancy such as myocardial infarction, peripartum cardiomyopathy, rheumatic heart disease, aortic dissection, and congenital heart disease. It provides recommendations on risk assessment, preconception counseling, antepartum care, intrapartum management, and postpartum care for women with cardiac conditions.
This document discusses the pros and cons of transferring embryos on day 5 (blastocyst stage) versus day 3. It raises questions about whether day 5 transfer should be routine practice and whether there are any adverse effects. Specifically, it notes that day 5 transfer is not suitable for all women, especially those with a limited number of embryos, and that an increased incidence of autism has been reported. It also discusses whether day 5 transfer is practical given the infrastructure needed, and whether it is really of any value if more than one embryo is being transferred. The conclusion is that day 5 transfer should only be offered for highly selected cases.
1) Laparoscopic ablation of minimal or mild endometriosis in women with subfertility aims to increase pregnancy rates but evidence from randomized trials is limited and inconclusive.
2) Two randomized trials found slightly higher pregnancy rates with ablation but the number needed to treat was high at 8 women to achieve one additional pregnancy.
3) A prospective cohort study found no significant difference in fecundity rates between women with minimal/mild endometriosis and unexplained infertility.
This document provides evidence-based recommendations for managing unexplained infertility. It discusses various treatment options including expectant management, oral agents with or without IUI, gonadotropins with IUI, and IVF. The key recommendations are that IUI in natural cycles or with oral agents is no more effective than expectant management. Gonadotropins with IUI can be offered but carries a higher risk of multiple pregnancy. IVF demonstrates superior pregnancy rates compared to other options and should be offered after failed ovarian stimulation cycles. Immediate IVF is recommended for women over 38 years old with unexplained infertility.
1. The document discusses new concepts in infertility including updated WHO reference values for semen analysis, the use of ICSI for male factor infertility, and success rates varying based on the cause of infertility.
2. ICSI, where surgically retrieved sperm are injected into eggs, has become an established procedure for couples with male subfertility to have a biological child, with reassuring post-natal outcomes reported so far.
3. The success of IVF depends on the type of infertility, with male factor infertility seeing live birth rates around 40% and female factor infertility around 25%, higher than other causes of infertility.
Unlocking I.V.F Services Redefining the New Normal Dr Sharda Jain Lifecare Centre
1) Frozen embryo transfer (FET) will likely be the treatment of choice after resumption of fertility practice due to its less invasive nature compared to fresh embryo transfer which involves ovarian stimulation.
2) FET cycles are associated with higher success rates than fresh embryo transfers in high responders who produce 15 or more eggs. They also carry lower risks of adverse outcomes like preterm birth and low birth weight.
3) To reduce stress experienced by ART patients during the pandemic, it is recommended to practice digital detox, meditation, interact with support groups, use self-help resources and maintain positive self-talk.
TSH levels and thyroid autoimmunity can impact fertility. Thyroid dysfunction is more prevalent in infertile couples compared to fertile controls. Treatment of overt hypothyroidism improves fertility outcomes, while treatment of subclinical hypothyroidism or suppressed TSH may not provide benefits. Guidelines recommend treating hypothyroidism when TSH is above 10 or between 4-10 if thyroid antibodies are present. Screening for thyroid issues is reasonable in infertile women, women over 35, or those with irregular periods or family history of thyroid disease.
Senturk, lm emas webinar infertility and hyperandrogenism_20181205TrkiyeMenopozVeOsteo
This document summarizes fertility problems in women with androgen excess. It discusses various causes of hyperandrogenism including polycystic ovary syndrome (PCOS), which accounts for 80% of cases. It then outlines treatment approaches including lifestyle management, pharmacological options, and assisted reproductive technologies. First line pharmacological treatments include combined oral contraceptives, anti-androgens, and metformin. Second line options include gonadotropins and laparoscopic ovarian drilling.
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
The document discusses unexplained recurrent miscarriage (URPL), defined as three or more consecutive pregnancy losses before 20 weeks where standard testing does not reveal a cause. It notes URPL occurs in 1% of couples and risk increases with age and infertility. While identifiable causes are found in 50% of recurrent miscarriage cases, the cause remains unknown in 50% (URPL). Standard testing is outlined. Possible treatment options for URPL discussed include aspirin, progesterone, steroids, low molecular weight heparin, immunotherapy, and tender loving care. One matched-pair study showed progesterone/prednisolone/aspirin treatment significantly increased live birth rates and decreased miscarriage compared to controls.
Unexplained infertility refers to the inability to conceive after one year despite routine investigations showing no abnormalities. While the causes are uncertain, treatments aim to increase monthly pregnancy rates and include expectant management, clomiphene citrate, gonadotropins, IUI, IVF, and lifestyle changes. Couples with unexplained infertility have higher risks of obstetric complications and should follow a progressive treatment plan based on factors like duration of infertility and age.
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.
The document discusses unexplained infertility, providing definitions and discussing prevalence, causes, diagnosis, and treatment options. It notes that unexplained infertility affects 10-20% of couples and can cause psychological distress. Potential causes are discussed but many are uncertain and found in fertile couples. Diagnosis involves ruling out known causes through standard investigations. Treatment aims to increase monthly pregnancy rates and options discussed include expectant management, ovulation induction, IUI, IVF, and alternative therapies like letrozole, with success rates provided for each option.
1) Maternal hypothyroidism is associated with adverse outcomes for both mother and fetus such as gestational hypertension, preeclampsia, spontaneous abortion, preterm delivery, and impaired cognitive function in the child.
2) Screening pregnant women for thyroid dysfunction is recommended by some experts and organizations based on criteria such as the disease prevalence during pregnancy, availability of safe and inexpensive testing, and whether treatment can improve outcomes.
3) While some studies found an association between subclinical hypothyroidism and adverse outcomes, others did not, so the effects of subclinical hypothyroidism are unclear. Universal screening is superior to selective screening at detecting thyroid abnormalities but the benefits of treatment are still debated.
Epidemiology of Recurrent Pregnancy LossKirtan Vyas
1) Recurrent pregnancy loss is defined as 3 or more consecutive spontaneous miscarriages under 20 weeks gestation. Causes include genetic factors, anatomical abnormalities, endocrine/metabolic issues, thrombophilias, and immunological factors.
2) Evaluation may include tests for parental chromosomal issues, uterine anomalies, thyroid function, diabetes, lupus/antiphospholipid antibodies, and thrombophilias. However, in many cases no cause can be identified.
3) Prognosis is generally good - the majority will have a successful pregnancy with supportive care alone. Counseling focuses on reassuring patients while managing expectations given uncertainty around empirical treatments.
Luteal Phase Support: Key Variables to Achieve Success in ARTSandro Esteves
This document discusses luteal phase support in assisted reproductive technology cycles. It covers:
1. The pathophysiology of the luteal phase defect in stimulated cycles and the role of progesterone supplementation.
2. Different luteal phase support protocols after hCG trigger in fresh embryo transfer cycles, including progesterone alone versus progesterone plus hCG or GnRH agonist.
3. Luteal phase support considerations for frozen embryo transfer cycles, including the type and timing of estrogen and progesterone administration.
Update (2021) Oral Contraceptive Pill : Dr. Jyoti Agarwal Dr Sharda Jain Lifecare Centre
Update (2021) Oral Contraceptive Pill : Dr Sharda Jain
7 Billion 2011 & increasing a rate of 150 million per year
INDIA
Today – 1.3 billion 2050 – 1.628 expected
This document provides guidance on cardiac disease and pregnancy. It notes that cardiac disease is a leading cause of maternal death in developed countries. The purpose is to summarize expert opinions to help plan management of affected pregnancies until more evidence is available. It discusses various types of cardiac conditions that pose risks in pregnancy such as myocardial infarction, peripartum cardiomyopathy, rheumatic heart disease, aortic dissection, and congenital heart disease. It provides recommendations on risk assessment, preconception counseling, antepartum care, intrapartum management, and postpartum care for women with cardiac conditions.
This document discusses the pros and cons of transferring embryos on day 5 (blastocyst stage) versus day 3. It raises questions about whether day 5 transfer should be routine practice and whether there are any adverse effects. Specifically, it notes that day 5 transfer is not suitable for all women, especially those with a limited number of embryos, and that an increased incidence of autism has been reported. It also discusses whether day 5 transfer is practical given the infrastructure needed, and whether it is really of any value if more than one embryo is being transferred. The conclusion is that day 5 transfer should only be offered for highly selected cases.
1) Laparoscopic ablation of minimal or mild endometriosis in women with subfertility aims to increase pregnancy rates but evidence from randomized trials is limited and inconclusive.
2) Two randomized trials found slightly higher pregnancy rates with ablation but the number needed to treat was high at 8 women to achieve one additional pregnancy.
3) A prospective cohort study found no significant difference in fecundity rates between women with minimal/mild endometriosis and unexplained infertility.
This document provides evidence-based recommendations for managing unexplained infertility. It discusses various treatment options including expectant management, oral agents with or without IUI, gonadotropins with IUI, and IVF. The key recommendations are that IUI in natural cycles or with oral agents is no more effective than expectant management. Gonadotropins with IUI can be offered but carries a higher risk of multiple pregnancy. IVF demonstrates superior pregnancy rates compared to other options and should be offered after failed ovarian stimulation cycles. Immediate IVF is recommended for women over 38 years old with unexplained infertility.
1. The document discusses new concepts in infertility including updated WHO reference values for semen analysis, the use of ICSI for male factor infertility, and success rates varying based on the cause of infertility.
2. ICSI, where surgically retrieved sperm are injected into eggs, has become an established procedure for couples with male subfertility to have a biological child, with reassuring post-natal outcomes reported so far.
3. The success of IVF depends on the type of infertility, with male factor infertility seeing live birth rates around 40% and female factor infertility around 25%, higher than other causes of infertility.
Unlocking I.V.F Services Redefining the New Normal Dr Sharda Jain Lifecare Centre
1) Frozen embryo transfer (FET) will likely be the treatment of choice after resumption of fertility practice due to its less invasive nature compared to fresh embryo transfer which involves ovarian stimulation.
2) FET cycles are associated with higher success rates than fresh embryo transfers in high responders who produce 15 or more eggs. They also carry lower risks of adverse outcomes like preterm birth and low birth weight.
3) To reduce stress experienced by ART patients during the pandemic, it is recommended to practice digital detox, meditation, interact with support groups, use self-help resources and maintain positive self-talk.
TSH levels and thyroid autoimmunity can impact fertility. Thyroid dysfunction is more prevalent in infertile couples compared to fertile controls. Treatment of overt hypothyroidism improves fertility outcomes, while treatment of subclinical hypothyroidism or suppressed TSH may not provide benefits. Guidelines recommend treating hypothyroidism when TSH is above 10 or between 4-10 if thyroid antibodies are present. Screening for thyroid issues is reasonable in infertile women, women over 35, or those with irregular periods or family history of thyroid disease.
Senturk, lm emas webinar infertility and hyperandrogenism_20181205TrkiyeMenopozVeOsteo
This document summarizes fertility problems in women with androgen excess. It discusses various causes of hyperandrogenism including polycystic ovary syndrome (PCOS), which accounts for 80% of cases. It then outlines treatment approaches including lifestyle management, pharmacological options, and assisted reproductive technologies. First line pharmacological treatments include combined oral contraceptives, anti-androgens, and metformin. Second line options include gonadotropins and laparoscopic ovarian drilling.
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
The document discusses unexplained recurrent miscarriage (URPL), defined as three or more consecutive pregnancy losses before 20 weeks where standard testing does not reveal a cause. It notes URPL occurs in 1% of couples and risk increases with age and infertility. While identifiable causes are found in 50% of recurrent miscarriage cases, the cause remains unknown in 50% (URPL). Standard testing is outlined. Possible treatment options for URPL discussed include aspirin, progesterone, steroids, low molecular weight heparin, immunotherapy, and tender loving care. One matched-pair study showed progesterone/prednisolone/aspirin treatment significantly increased live birth rates and decreased miscarriage compared to controls.
Unexplained infertility refers to the inability to conceive after one year despite routine investigations showing no abnormalities. While the causes are uncertain, treatments aim to increase monthly pregnancy rates and include expectant management, clomiphene citrate, gonadotropins, IUI, IVF, and lifestyle changes. Couples with unexplained infertility have higher risks of obstetric complications and should follow a progressive treatment plan based on factors like duration of infertility and age.
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.
The document discusses unexplained infertility, providing definitions and discussing prevalence, causes, diagnosis, and treatment options. It notes that unexplained infertility affects 10-20% of couples and can cause psychological distress. Potential causes are discussed but many are uncertain and found in fertile couples. Diagnosis involves ruling out known causes through standard investigations. Treatment aims to increase monthly pregnancy rates and options discussed include expectant management, ovulation induction, IUI, IVF, and alternative therapies like letrozole, with success rates provided for each option.
1) Maternal hypothyroidism is associated with adverse outcomes for both mother and fetus such as gestational hypertension, preeclampsia, spontaneous abortion, preterm delivery, and impaired cognitive function in the child.
2) Screening pregnant women for thyroid dysfunction is recommended by some experts and organizations based on criteria such as the disease prevalence during pregnancy, availability of safe and inexpensive testing, and whether treatment can improve outcomes.
3) While some studies found an association between subclinical hypothyroidism and adverse outcomes, others did not, so the effects of subclinical hypothyroidism are unclear. Universal screening is superior to selective screening at detecting thyroid abnormalities but the benefits of treatment are still debated.
Epidemiology of Recurrent Pregnancy LossKirtan Vyas
1) Recurrent pregnancy loss is defined as 3 or more consecutive spontaneous miscarriages under 20 weeks gestation. Causes include genetic factors, anatomical abnormalities, endocrine/metabolic issues, thrombophilias, and immunological factors.
2) Evaluation may include tests for parental chromosomal issues, uterine anomalies, thyroid function, diabetes, lupus/antiphospholipid antibodies, and thrombophilias. However, in many cases no cause can be identified.
3) Prognosis is generally good - the majority will have a successful pregnancy with supportive care alone. Counseling focuses on reassuring patients while managing expectations given uncertainty around empirical treatments.
there is a change in attitude for monofollicular ovulation induction to treat infertility: previously clomiphene citrate was the standard drug to start with : Now it is different
Unexplained infertility accounts for 10-20% of infertility cases. While basic tests like semen analysis, HSG, and ovulation documentation are recommended, more advanced tests like laparoscopy can provide diagnoses in some cases. Treatment options aim to improve gamete quality, increase gamete numbers, and facilitate interaction. Studies have found IVF to be more effective than IUI for unexplained infertility, resulting in higher pregnancy rates and fewer total treatment cycles. Some forms of unexplained infertility may be due to subtle, unidentified issues that IVF is better able to overcome compared to less invasive treatments.
(마더세이프라운드) Thyroid disease in pregnancy mothersafe
This document summarizes the evidence and guidelines regarding screening for thyroid disease during pregnancy. It finds that while screening for subclinical hypothyroidism remains controversial, screening for overt thyroid disease is recommended due to the clear adverse maternal and fetal effects of untreated overt hypothyroidism and hyperthyroidism. Universal screening is superior to selective screening in detecting thyroid dysfunction in pregnant women. Given the high prevalence of thyroid abnormalities in pregnant women, especially in Korea where most women are over 30 years old at their first prenatal visit, universal screening is considered appropriate.
Dr. Vandana Bansal is a senior gynaecologist and obstetrician who specializes in infertility and IVF. She directs the Arpit Test Tube Baby Centre in Prayagraj, India. The document discusses intrauterine insemination (IUI), providing rationales for its use, details on techniques and protocols, success rates based on factors like age and ovarian stimulation methods, and alternatives when IUI is unsuccessful. It summarizes evidence from clinical studies on optimizing IUI outcomes.
This document discusses infertility evaluation and treatment. It begins by outlining factors to consider before trying to conceive and describing methods for timing intercourse. Common causes of infertility include problems with ovulation, male factor issues, and tubal or uterine abnormalities. Treatment options range from lifestyle changes to assisted reproductive technologies like intrauterine insemination, ovulation induction, and in vitro fertilization. While assisted reproduction can help many couples conceive, it may also lead to multiple births and there are still some unknown risks for children conceived through these methods.
Is there a place for progesterone in the management of miscarriage?drmattprior
Miscarriage is the commonest complication in pregnancy. One in four pregnancies ends this way. The physical experience can be awful in itself, but in the words of a patient, "the grief of miscarriage can last forever."
The commonest question for women who have experienced miscarriage is simple--why did it happen? The answer is rarely apparent.
Many so-called "treatments" to prevent miscarriage are unproven. But recent research suggests some miscarriages may be prevented with progesterone.
In this talk for clinicians, I explored the most recent evidence.
This document outlines a 4G ovarian stimulation protocol. It discusses mono follicular versus multifollicular development and the use of gonadotropins, clomiphene citrate, and low-dose FSH for ovulation induction. It also reviews luteal phase support strategies and cost considerations for different stimulation protocols. The document presents data from clinical trials comparing stimulation methods and concludes that gonadotropins are the most effective for ovulation induction and IVF, though cost must also be considered.
Pragmatic Open-Label Randomized Trial of Pre-Exposure Prophylaxis: the PROUD ...Office of HIV Planning
Kathleen Brady of the Philadelphia Department of Public Health shared slides about the PROUD study, originally presented at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI), at the March 2015 meeting of the Philadelphia HIV Prevention Planning Group (HPG).
This document outlines a 4G ovarian stimulation protocol. It discusses mono follicular versus multifollicular development in ovarian stimulation for IUI and IVF/ICSI. It also discusses luteal phase support strategies, including route of progesterone administration. Recombinant FSH, HMG, and gonadotropin dose are discussed. The document concludes by discussing a business model for an IVF center located within a hospital.
This randomized controlled trial examined whether routine hysteroscopy prior to the first IVF treatment cycle improves live birth rates. The study assigned 750 women to either hysteroscopy followed by IVF (intervention group) or immediate IVF without hysteroscopy (control group). There was no significant difference in live birth rates between the groups, with 55% of the hysteroscopy group and 51% of the immediate IVF group achieving a live birth. The median time to pregnancy was also similar between groups. The study concludes that hysteroscopy does not improve IVF outcomes in subfertile women with a normal transvaginal ultrasound.
How does one increase the chances of success when carrying out intra uterine insemination (IUI) procedures in places carrying out assisted reproductive technologies (ART)?
This document summarizes various ART options for poor ovarian responders. It discusses criteria for defining poor ovarian response, classification systems like POSEIDON, and studies comparing outcomes of different stimulation protocols. These include mild versus conventional stimulation, different gonadotropin doses and add-backs, natural cycles, estrogen priming, and supplements like DHEA, growth hormone, and CoQ10. Cumulative live birth rates are provided for various patient groups over multiple cycles, showing rates ranging from 12-75% depending on age and ovarian reserve.
medical management of infertility,think before surgery!!!!ShitalSavaliya1
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.
This randomized controlled trial compared the effectiveness and safety of minimal stimulation IVF (mini-IVF) to conventional IVF. 564 women were randomly assigned to either mini-IVF using oral clomiphene and gonadotropins followed by a freeze-all policy, or conventional IVF using high dose gonadotropins and fresh double embryo transfer. The primary outcome was cumulative live birth rate within 6 months, and secondary outcomes included pregnancy rates, ovarian hyperstimulation syndrome, and multiple pregnancy rates. Results showed mini-IVF resulted in comparable live birth rates but significantly lower risks of ovarian hyperstimulation syndrome and multiple pregnancies compared to conventional IVF.
It was while performing SUZI that a single spermatozoon accidentally penetrated into the oolemma and provided the hint that a direct sperm injection would be more efficient.
1st successful birth by ICSI took place on Jan 14, 1992.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Mild ovarian stimulation in women with poor ovarian reeserve (PRIMA)
1. Mild versus conventional
ovarian stimulation for IVF/ICSI treatment
in women with poor ovarian reserve
(PRIMA Trial)
Youssef M.A.F.M
Al-Inany H.
2. Background
• The age of women giving birth to
their first child is rising
• Older women have decreased
fecundity
• Consequently, more older women
will request IVF
of poor ovarian response is 9-24%
5. Aim of PRIMA trial
• To evaluate the effectiveness and safety of a mild
stimulation IVF versus a conventional simulation IVF in
women with poor ovarian reserve undergoing IVF
treatment
6. 394 couples poor ovarian reserve
197 couples
Mild IVF
197 couples
Conventional IVF
treatmenttime
OCP+ 150 IU FSH + GnRH
antagonist
Mid-Luteal Long GnRH agonist
+ 450 IU HMG
Ongoing Pregnancy
recruitme
nt
endpoint
PRIMA trial design
7. Couples
Inclusion criteria
•Women with an indication for IVF
•Aged > 35 years
•and/or women who have FSH >10 IU/ml
•and/or women who have AFC (< 7 follicles)
•Women who responded poorly during their 1st
IVF cycle irrespective
of their age.
Exclusion criteria
•Women with pre-existing medical conditions,
•Women > 43 years old;
•Women with uterine anomalies; polycystic ovary syndrome and
anovulation
8. 450 IU HMG /day
mid-luteal GnRH agonist
hCG OPU ET
Menstr.
Mild Ovarian stimulation IVF
Conventional Ovarian stimulation/IVF
Interventions
150 IU FSH/day
5 days
After laatste pil
GnRH antagonist
Sd 6
hCG OPU ET
PIL ( ≥ 10 days)
Cd2-3
Menstr.
10. Analysis
Sample size calculation
• Non inferiority design
• Considering an ongoing pregnancy rate of 15 % in both treatment
groups, with an alpha of 5% and a beta of 20%, 197 patients per
group were required to exclude a difference of 10% to the determent
of the mild protocol.
• preplanned blinded interim analysis was performed when 200 women
had completed follow-up
Intention to treat
Trial registeration: NTR2788
11. Mild stimulation Conventional
stimulation
394 women randomized
Lost to follow-up/drop out (n=16)
Discontinued intervention (n= 43)
1 woman discontinue dthe intervention: no suppression
26 Women cancelled due to poor ovarian response & 2
women changed to IUI
4 no oocytes/MII
10 fertilization failure
Lost to follow-up/drop out (n=18)
Discontinued intervention (n= 56)
3 women discontinued the intervention: spontaneous
ovulation/no suppression/ financial reason
35 Women cancelled due to poor ovarian response & 2 women
changed to IUI
4 no oocytes/MII
12 cycles with fertilization failure
Received allocated intervention:191
Did not receive allocated intervention: 6
2 women antagonist was not available,
1 declined consent,
1 insisted on sex selection,
1 had fibroids
Received allocated intervention:195
Did not receive allocated
intervention:2
1 woman received fault drug,
1 decline their consent,
Flow chart
Allocation
Follow up
Analysis
Analyzed : ITT: 197 Analyzed : ITT: 197
12. Baseline characteristics
Mild stimulation
(N=197)
conventional stimulation
(N=197)
Age in years (µ ±SD) 36.52± 3,963 36.63±4.287
BMI in Kg/m2
(µ ±SD) 27.19±4.486 27.45±5.282
D. Infertility in years ( µ ±SD) 9.43±5.6 9.28±5.7
Primary infertility, n (%) 143 (74.9) 138 (71.9)
AFC (µ ±SD) 6.2±2.8 6.5± 2.9
FSH (µ±SD) 11.4±4.3 10.5±4.0
E2(µ±SD) 43.8±22.6 42.8±25.7
AMH (µ ±SD) (n= 301) 0.52±0.62 0.6±0.66
15. Ovarian stimulation outcomes
Mild stimulation
(N=197)
Conventional
stimulation (N= 197)
p
No. of stimulation days ( µ ±SD) 95% CI) 8.9±2.6 10.2± 2.5 0.00
Total amount of FSH ( µ ±SD) 1394.4 ±366.4 ---
0.00
Total amount of HMG (µ ±SD) ----- 4852.4±3650.6
No. cycle cancellation rate due to poor ovarian
response, n (% )
35 (18.7) 26 (13.9) 0.32
No. of follicles ≥ 15 mm on hCG day ( µ ±SD) 3.4± 3.0 4.7± 3.6 0.06
16. Ovarian stimulation outcomes
Mild stimulation
(n=197)
Conventional
stimulation
(n=197)
p
No. of oocytes (µ ± SD) 3.58 ± 3.7 5.2 ± 4.1 0.59
No. of MII oocytes (µ± SD) 2.8±3.0 4.2±3.7 0.01
Fertilization rate (µ ± SD) 2.4±2.6 3.5±3.1 0.39
Total number of embryos 349 365
No. of top quality embryos (95% CI) 0.54 (0.37- 0.71) 0.75 (0.51-1.0) 0.94
No. of embryos transferred (µ ± SD) 1.5±1.4 1.7±1.2 0.056
No. embryos frozen (µ ± SD) 0.82±1.1 0.64±1.9 0.45
17. Summary
• Mild ovarian stimulation is non-inferior to conventional ovarian
stimulation in terms of pregnancy outcomes
• Mild ovarian stimulation is associated with shorter duration of stimulation
and lower amount of gonadotropins.
• Mild ovarian stimulation is associated with less MII oocytes.
18. Take home message
Mild ovarian stimulation is the preferred alternative to
conventional stimulation in women with poor reserve
undergoing IVF treatment
19. Acknowledgment
Dr. M. Van Wely
Dr. M. Mochtar
Prof. F.van der Veen
Prof. Dr. Tahereh Madani
Dr. Nadia Jahangiri
Dr. Shabnam Khodabakhshi
Prof. Dr. M. Akhondi
Dr. S. Abouzar
Prof. Dr. Marwan Halabi
Prof. Dr. S.Khattab
Prof. Dr. Ismail .Aboulfoutouh
Dr. Maged El-mohamedy
Dr. Eman Kamal shoair
Prof. Dr. Ahmed Youssef Rizk