Individualizing Ovarian Stimulation Protocols for IVFSherInstitute
Have you experienced poor response to IVF medications? Been told you had "Empty Follicle Syndrome?" Had lots of eggs retrieved but very few fertilized? Experienced Ovarian Hyperstimulation Syndrome? All of these issues can be tied to or affected by your protocol of stimulation. Dr. Geoffrey Sher presents his approach to customizing ovarian stimulation based on 30 years' experience in the IVF field. He outlines a number of his stimulation protocols and discusses the factors that can cause IVF failure due to improper stimulation protocols.
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Role of antioxidants in female infertility Dr. Jyoti AgarwalLifecare Centre
Role of antioxidants in female infertility Dr. Jyoti Agarwal
3 Concepts
Oxygen toxicity is an inherent challenge to aerobic life
Oxygen is essential for life.
Excess oxygen can have harmful effects.
When oxygen is metabolised in the body , it produces substances called FREE RADICALS which damage our cells.
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
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
Oxidative Stress is a major contributor of unexplained female infertility and male factor infertility.Recent Cochrane database metanalysis suggests there is a low but significant improvement in fertility with use of various micronutrients and antioxidant supplements.
Individualizing Ovarian Stimulation Protocols for IVFSherInstitute
Have you experienced poor response to IVF medications? Been told you had "Empty Follicle Syndrome?" Had lots of eggs retrieved but very few fertilized? Experienced Ovarian Hyperstimulation Syndrome? All of these issues can be tied to or affected by your protocol of stimulation. Dr. Geoffrey Sher presents his approach to customizing ovarian stimulation based on 30 years' experience in the IVF field. He outlines a number of his stimulation protocols and discusses the factors that can cause IVF failure due to improper stimulation protocols.
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Role of antioxidants in female infertility Dr. Jyoti AgarwalLifecare Centre
Role of antioxidants in female infertility Dr. Jyoti Agarwal
3 Concepts
Oxygen toxicity is an inherent challenge to aerobic life
Oxygen is essential for life.
Excess oxygen can have harmful effects.
When oxygen is metabolised in the body , it produces substances called FREE RADICALS which damage our cells.
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
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
Oxidative Stress is a major contributor of unexplained female infertility and male factor infertility.Recent Cochrane database metanalysis suggests there is a low but significant improvement in fertility with use of various micronutrients and antioxidant supplements.
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.
Adjuvant therapy, also known as adjunct therapy or add-on therapy, is therapy given in addition to the primary or initial therapy to maximize its effectiveness.
Add-ons have become ubiquitous with the process of assisted reproduction (ART) which is markedly more complex than it was at its inception.
ABSTRACT- Background: Endometriosis is associated with chronic, benign, oestrogen-dependent inflammatory
disease that affects approximately 10% of reproductive age women and 35-50% of women with pelvic pain and
infertility. It can be a weakening disease with dysmenorrhoea, dyspareunia, and chronic pelvic pain symptoms.
Objective: To evaluate the role of serum marker (IL-6, IL-8, TNF-α) as non-invasive tool to diagnose endometriosis in
reproductive age group.
Methods: A case control study was conducted in Department of Obstetrics and Gynecology, KGMU, Lucknow for a
period of one year. Total numbers of women enrolled in study were 100. Out of 100 women, 75 women of reproductive
age group with clinical suspicion and USG findings were taken as cases. Out of 75 cases, 12 cases lost the follow up
and 26 cases kept on conservative management and they responded well. Finally 37 cases of endometriosis with strong
clinical suspicions (Dysmenorrhea, Heavy or irregular bleeding, Pelvic pain, Lower abdominal or back pain,
Dyspareunia, Dyschezia) and USG finding of endometriosis were recruited as cases and they underwent laparoscopy/
laparotomy. Control group comprises of 25 women undergoing for laparoscopic tubal ligation. After taking informed
consent, all the women were subjected to the detailed menstrual, gynaecological, medical history and general, systemic
and gynaecological examination. Patient was investigated for haemoglobin, ultrasound abdomen and pelvis and serum
markers (IL-6, IL-8, TNF-α). Blood sample (5ml of blood) was collected in vecutainer tube for serum analysis. The
blood was centrifuged to separate the serum and stored at -70ºC till examined. Finally 37 cases of endometriosis
underwent laparotomy/laparoscopy (gold standard to diagnose endometriosis) for proper diagnosis and treatment.
Results: Serum IL-8 cut-off at 0.78% pg/ml afforded a sensitivity of 70.3% and specificity of 80% in the diagnosis of
endometriosis and has good discriminant ability. TNF-α has average discriminant ability, 62.2% sensitivity and 56%
specificity for endometriosis diagnosis. So that serum IL-8 and TNF-α can differentiate cases with or without
endometriosis. By detecting these serum markers, we can diagnose endometriosis without undergoing laparoscopy or
laparotomy.
Conclusion: The serum markers (IL-8, TNF-α) can be used as a non-invasive tool for diagnosis of endometriosis.
Key-words- Endometriosis, Interleukins, Tumour necrosis factor, Laparoscopy
Evidence linked treatment for endometriosis-associated infertilityApollo Hospitals
Endometriosis is conventionally defined as the presence of
tissue lesions or nodules that are histologically similar to
the endometrium, but are present at sites outside the uterus.It is a chronic, often recurring disease of complex and unclear aetiology. Endometriosis is a highly variable condition in terms of age and mode of presentation, range of symptoms, anatomical sites, response to treatment and likelihood of recurrence.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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!
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
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.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NONHORMONAL DRUGS FOR MALE INFERTILITY BY DR SHASHWAT JANI
1. Dr. Shashwat Jani.
M. S. ( Obs – Gyn ), F.I.A.O.G.
Diploma in Advance Laparoscopy,
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : +91 99099 44160.
E-mail : drshashwatjani@gmail.com
2. Why Non Hormonal ???
The nonhormonal medical treatment
has a relevant role in male infertility since
it may solve the cause of infertility,
whereas in some other times it may
ameliorate sperm parameters by improving
the environment where spermatozoa are
produced and mature.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
2
3. Aside from endocrine causes, three
often coexisting conditions interfering with
the reproductive function may require
nonhormonal treatment:
1. Infection
2. Inflammation
3. Increased Oxidative Stress
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
3
4. Infection
• A nonempirical treatment for infertility due
to urogenital tract infections has been based
on the use of specific antibiotics, following
identification of the microorganisms by
appropriate microbiological investigation and
the relative antibiogram.
• We can distinguish the presence of
microorganisms, therefore, as microbial or
inflammatory forms.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
4
5. Causative Organisms
• Gram-negative bacteria (Enterobacteriaceae such as Escherichia
coli, Klebsiella species, Proteus, Serratia, and Pseudomonas species)
and etiological agents of sexually transmitted diseases (Chlamydia
trachomatis, Ureaplasma urealyticum, Treponema pallidum, Neisseria
gonorrhoeae, etc.) are recognized as “certain pathogens” of the
prostate.
• On the other hand, some microorganisms of the prostate, which
are occasionally detectable in the urogenital tract, are considered by
some authors to be “nonpathogenic,” “likely pathogens,” “occasional
pathogens” (Gram-positive germs, such as Enterococcus spp.,
Staphylococcus aureus, and obligate anaerobes), or “possible
pathogens” (coagulasenegative germs, such as Staphylococcus
haemolyticus, Staphylococcus epidermidis, and mycoplasmas).
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
5
6. Quinolones are considered a first-line therapy.
Cipro & Levo are common.
Trimethoprim is active against many relevant
pathogens ( 2nd Line Therapy ).
Tetracyclines have good activity against
Chlamydia trachomatis and Mycoplasma .
Doxycycline is administered at the dose of
100mg once or twice/day for 28 days.
Recently, an elevated frequency of HPV infection
in patients with infertility , as a viral form,
cannot rely on antibiotic treatment.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
6
7. The most frequently used families of
antimicrobial drugs for the treatment of the
microbial forms are fluoroquinolones, macrolides,
and tetracyclines.
Higher eradication rates (>90%) have been
reported with azithromycin and levofloxacin either
alone, in combination, or sequentially, depending
upon the infection site (urethral, prostatic, or both)
in patients with chronic bacterial prostatitis by
Chlamydia trachomatis infection.
Cephalosporins, monobactams, and
carbapenems have a limited use in male infertility.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
7
8. Many studies and researches have
proved that there is a strong positive
relationship between Micronutrients &
Male fertility.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
8
9. In order to examine the association
between micronutrients and infertility,
articles with case-control, descriptive,
cohort, and interventional (clinical trials)
design, published between 1984 and 2014,
were accessed through PubMed and
Embase databases, using keywords such as
“micronutrients “ , "oxidative stress",
"antioxidant", "vitamins", "minerals", and
"infertility“….
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
9
10. Anti-inflammatory Drugs
NSAIDs should be considered for the
treatment of the acute forms of male
accessory gland inflammation for symptoms
relief and they should be avoided for chronic
usage (if possible) in patients with infertility.
Glucocorticoids are employed for the
treatment of infertility when antisperm
antibodies (ASA) are demonstrated.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
10
12. Infertility affects about 15 – 20 % of
married couples half of which attributed to
male infertility.
Defective sperm function considered to be
most common cause of male infertility.
Apart from all the conventional causes of
male infertility , a new & important cause has
been identified as being responsible for
Idiopathic male infertility :
Reactive Oxygen Species ( ROS ).
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
12
13. Causes for Male Infertility
31.7
16.6
9
8.9
8.5
5.8
5
4.2
2.3
1.5
6.5
0 5 10 15 20 25 30 35
Idiopathic
Varicocele
Infection
Hypogonadism
Cryptorchidism
Malformation
Systemic
Immunologic
Tumor
Obstruction
Other
Hum Reprod Update 1999;5(2):120Percent (%)
1330-Jul-18
Dr Shashwat Jani
+91 99099 44160.
14. Idiopathic male Subfertility
40-75% of cases.
Most common pathological cause of
Idiopathic Subfertility is –
‘ free radical induced damage to the sperm. ‘
Free radical is defined as…
‘ Oxygen molecule containing one or more
unpaired electrons in atomic or molecular
orbitals.’
1430-Jul-18
Dr Shashwat Jani
+91 99099 44160.
15. R.O.S.
• In a healthy man, a delicate balance
exists between physiological ROS &
Antioxidants in the male reproductive
tract.
• High level of seminal ROS have been
found in 30 – 80 % of infertile men.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
15
16. Biology of ROS
Pathology stems from imbalance between
production and scavenging
Production Degradation
1630-Jul-18
Dr Shashwat Jani
+91 99099 44160.
17. ROS and Male Infertility
Urology. 1996;48(6):835–850.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
17
20. 1) Poor sperm motility
2) Teratozoospermia
3) High number of round cells in semen
4) Increased semen viscosity
5) Poor sperm membrane integrity on hypo osmoler
swelling test
6) Poor fertilization on routine IVF.
7) Poor sperm motility after overnight oocyte
incubation
8) Poor blastocyst development in absence of a clear
female factor.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
20
21. Nutritional Considerations
• Various micronutrients are
associated with male fertility.
• Deficiency of these
micronutrients may result in
infertility.
Nutritional
Factors
Free radical
scavengers
L-Carnitine Lycopene
Coenzyme
Q10
Vitamin C
Zinc Vitamin E
Arginine Glutathione
Vitamin
B12
Selenium
Altern Med Rev. 2000;5(1):28-38.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
21
23. Nutrition plays vital role in maintaining male fertility:
Involved in the successful maturation of sperm
Provides nutrition for motility of sperm
Improvement in sperm count and motility
Helps in production of sex hormones
Prevents sperm damage
Reduction in sperm DNA fragmentation
Suppression of ROS production
Altern Med Rev. 2000;5(1):28-38.30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
23
27. Three compartments of the male genital
tract :
• Epididymal tissue,
• Seminal plasma, and
• Spermatozoa
Maintain the highest free L-carnitine
concentrations in the body.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
27
28. The main function of L-Carnitine in the
epididymis is to provide an energetic
substrate for spermatozoa.
May be involved in the successful
maturation of sperm.
L-Carnitine is necessary for transport of
fatty acids into the mitochondria to produce
energy.
Low levels of L-Carnitine reduces fatty
acid concentrations within the mitochondria,
leading to decreased sperm motility
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
28
29. L-Carnitine: Clinical Trials
According to a study conducted by Costa et al. L-carnitine
increased the sperm parameters drastically
10.8
28.4
3.73.1
142.4
18
32.5
4.1
20.3
163.3
0
20
40
60
80
100
120
140
160
180
Baseline At 4 months
Motile spermatozoa (%)
Mean velocity (microns)
Linearity index
Spermatozoa with rapid
linear progression (%)
Number of ejaculated
spermatozoa
Andrologia.1994;26:155-159.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
29
30. L- Carnitine for asthenospermia with
varicocele
Carnitine
Placebo
Zhonghua Nan Ke Xue. 2004;10(9):671–672.
There was significant improvement in sperm count,motility
and pregnancy rates in infertility due to varicocele. 30
31. L- Carnitine in idiopathic asthenozoospermia:
a multicenter study.
Italian Study Group on Carnitine and Male
Infertility.
Andrologia 1994;26:155-159
N = 100 patients
L-carnitine - 3 g/day
Duration - 4 months.
Percentage of motile spermatozoa increased from 26.9
± 1.1 to 37.7 ± 1.1 %.
Total number of spermatozoa per ejaculate also
increased
Conclusion - Oral administration of L-Carnitine
improves sperm quality
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
31
32. • Mazzilli et al, established strict correlation
between intrasperm L-carnitine content and sperm
motility survival in bovine cervical mucus. This is
possibly due to the fact that lipids are an important
energy source for sperm in cervical mucus and to
metabolize these lipids intrasperm Lcarnitine is
essential.
• L-carnitine not only helps in lipid metabolism
but also it modulates the reserves of free CoA,
essential for tricarboxylic acid ( TCA ) cycle regulation.
• Therefore, L carnitine content can be considered as an
indicator of sperm motility life span in cervical mucus.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
32
33. Anti Oxidant Property
It is also proposed that carnitine
exerts antioxidant properties as a
result of repairing mechanism by
which elevated intracellular toxic
acetyl-CoA is removed and fatty acids
in membrane phospholipids are
replaced.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
33
34. Co Enzyme Q 10
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
34
35. • In sperm cells, coenzyme Q10 (CoQ10) is concentrated in
the mitochondria.
• Coenzyme Q10 is responsible for energy for
movement and all other energy-dependent processes in the
sperm cell.
• Reduction in levels of CoQ10 is observed in sperm cells
and seminal plasma of idiopathic (IDA) and varicocele-
associated (VARA) asthenozoospermic patients.
• It is observed that sperm cells, characterized by low
motility and abnormal morphology, have low levels of CoQ10.
*Andrologia 34 (2002), 107–111.
Co enzyme Q10 - Mechanism
3530-Jul-18
Dr Shashwat Jani
+91 99099 44160.
36. • Administration of CoQ10
increased the pregnancy rate
by 36% and with
improvement of sperm count
and functional sperm
concentration in 70% and
60% individuals, respectively.
• Sperm motility and sperm
motility index improved in
54% and 46 % while 38 %
showed improvement in
sperm morphology.
Folia Med (Plovdiv).2005;47(1):26–30.
Coenzyme Q10: Clinical Trials
Improvement in sperm motility,
motility Index and
sperm morphology
Sperm
Morphology
Motility
index
Sperm
Motility
3630-Jul-18
Dr Shashwat Jani
+91 99099 44160.
39. Lycopene is a bright red pigment
and phytochemical found in tomatoes
and other red fruits, water melon &
guava.
Belongs to a class referred to as
carotenoids which are yellow, orange,
and red pigments synthesized by
plants .
Lycopene
3930-Jul-18
Dr Shashwat Jani
+91 99099 44160.
40. The general mechanism by which
Lycopene works is by preventing
oxidative damage to sperms, which
includes
• Damage to the cell membrane
• DNA molecules
• Lipids
• Proteins
Lycopene has been demonstrated to be the most
potent antioxidant with the ranking: lycopene > α-
tocopherol > α -carotene > β- carotene > lutein.
Lycopene – Biological activity
4030-Jul-18
Dr Shashwat Jani
+91 99099 44160.
44. Zinc is a micronutrient abundantly present in meat and
seafood and serves as a cofactor for more than 80 enzymes
involved in DNA multiplication and protein synthesis
Zinc deficiency is associated with decreased
testosterone levels & sperm count.
Zinc levels are generally lower in infertile men with
diminished sperm count.
Furthermore, zinc finger proteins are implicated in the
genetic expression of steroid hormone receptors*, and zinc also
has anti-apoptotic ** and antioxidant properties.***
*Endocr Rev 1992 :13,129–145.
**Curr Drug Targets 2003:4,323–338.
***Free Radic Biol Med 31,266–274.
Rev Prat. 1993;43:146-151.
Ann Nutr Metab. 1986;30:213-218.
4430-Jul-18
Dr Shashwat Jani
+91 99099 44160.
45. Effects of zinc supplementation on
subfertility
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
45
46. Zinc – Clinical Trials
N - 100 men with asthenozoospermia
Two groups--250 mg twice daily zinc therapy for 3 months
and no therapy.
Duration – 6 months
There was significant improvement in the sperm quality;
sperm count, progressive motility, fertilizing capacity.
Conclusion: Zinc therapy has a role in improving sperm
parameters in men with asthenozoospermia
Eur J Obstet Gynecol Reprod Biol. 1998 Aug;79(2):179-84.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
46
49. Arginine is essential for sperm motility, metabolism,
capacitation, acrosome reaction, and is a precursor for
producing petruscine, spermine, and spermidine.
According to a study by Schachter et al. Arginine
significant improved sperm count and motility after
taking 4 g/day for three months.
A recent study conducted in Itali also showed that
arginine is effective in male infertility
The recommended daily allowance (RDA) is 20 g,
with an upper limit of 30 g.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
49
51. Adequate folic acid intake is
associated with a decreased frequency
of sperm DNA abnormalities.
Still its role is controversial.
The RDA is 400 mg.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
51
53. 30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
53
Selenium and glutathione are essential to the
formation of phospholipid hydro peroxide
glutathione peroxidase.
Deficiencies of selenium can lead to instability of the
mid-piece, resulting in defective motility
However, it can be toxic if consumed in excess.
ArchAndrol. 1992;29:65-68. Science
1999;285:1393-1396.
Environ Mol Mutagen. 2009 [Epub ahead of
print]
55. • Vitamin B12 is important in cellular replication,
especially for the synthesis of RNA and DNA, and
deficiency states have been associated with
decreased sperm count and motility.
• Various studies have shown that Methylcobalamine
improves the sperm parameters
• However, studies show that Methylcobalamine is
effective in only just over 20% of infertile men.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
55
57. • Oral supplementation with vitamin E significantly
decreases the malondialdehyde concentration
and improves the sperm motility
• Although Invitro studies have prooved the
efficacy of vitamin E, human studies are lacking
• Although there are few human studies, they
recruited only few patients.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
57
58. To conclude
Infertile couples are likely to try multiple
Micronutrients hoping to improve their
chances of conception with minimal risk and
cost before proceeding with ART.
A recent Cochrane review in 2011 did
demonstrate improved pregnancy and live
birth rates with adequate dosages of
Micronutrients.
30-Jul-18
Dr Shashwat Jani
+91 99099 44160.
58