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.
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 .
Luteal phase insufficiency is one of the most important aspect of fertility treatment . But due to lack of proper understanding many unwanted medications are prescribed . This ppt will give an idea on the best evidence based luteal phase support for an ivf cycle.
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.
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 .
Luteal phase insufficiency is one of the most important aspect of fertility treatment . But due to lack of proper understanding many unwanted medications are prescribed . This ppt will give an idea on the best evidence based luteal phase support for an ivf cycle.
What trigger agent can be used when using assisted reproductive technologies when dealing with infertility?
Pros and cos of different techniques and what is used where.
IVF related information
Recurrent pregnancy loss - Uterine factorsAnu Manivannan
recurrent pregnancy loss - uterine factors based on fertility sterility journal - evidence based
Dr.Anu.M - Mch Resident - Department of Reproductive Medicine and Surgery
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
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
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
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
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”?
What trigger agent can be used when using assisted reproductive technologies when dealing with infertility?
Pros and cos of different techniques and what is used where.
IVF related information
Recurrent pregnancy loss - Uterine factorsAnu Manivannan
recurrent pregnancy loss - uterine factors based on fertility sterility journal - evidence based
Dr.Anu.M - Mch Resident - Department of Reproductive Medicine and Surgery
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
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
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
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
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”?
Kan boligers risiko for at stå tomme kortlægges ?Morten Fuglsang
Der opleves mange steder i Danmark et stigende antal boliger der står tomme og ubeboede hen - derfor kan det være gavnligt for planlæggerene at have et kendskab til hvilke faktorer der har indflydelse på at en bolig risikerer at stå tom. Denne analyse fokuserer på en gennemgang af de aktuelt tomme boliger i Ikast-Brande kommune, som vil blive hold op imod data fra BBR, SVUR og LOIS for at klassificere de tomme boliger på baggrund af den viden vi har om dem.
På baggrund af alle disse informationer vil en klassifikation af de tomme boliger blive forsøgt foretaget og baseret på disse mulige statistiske fællestræk, vil analysen blive udbredt, for at forsøge at estimere hvor mange boliger der kan være i risiko for at komme til at stå tomme ud fra de fundne indikatorer.
Gebelik endokrinolojisi, khd2014, namık kemal üniversitesiFatih Güven
Gebelik endokrinolojisi konusunda Speroff'un Klinik Jinekolojik Endokrinoloji ve İnfertilite kitabının 2007 basımlı Türkçe çevirisi kullanılarak hazırlanmıştır.Fotoğrafları kitaptan çektim, çok kaliteli olmadı fakat yeterli.
The uterine ageing affects endometrial receptivity, implantation, decidualization, and pregnancy outcomes. Animal and human in vitro studies are discussed. Donor egg program results in relation to recipients' age were compared between age groups.
Artificial Intelligence applications on Women's Health. Issues such as the prediction for bone loss, osteoporosis, stroke, myocardial infarction, ovarian cancer, endometrial cancer, cervical dysplasias and many more are discussed.
The World Health Organization (WHO) defined «healthy ageing»
as the process of developing and maintaining the functional ability
that enables wellbeing in older age. WHO describes this functional ability as being formed by interactions between intrinsic capacity and environmental characteristics.
The intrinsic capacity includes the mental and physical capacities of a person.
The environmental characteristics are related to home, community and society as a whole
1. 02.12.2016
1
Optimal Ovulasyon İndüksiyonu
nasıl olmalı ?
Dr Tevfik Yoldemir
Marmara Üniversitesi Tıp Fakültesi
Kadın Hastalıkları ve Doğum A.D.
tevfik@yoldemir.com
Teka hücresi
17-OH P A4
LH
+
P4
Pato-fizyoloji
Granuloza hücresi
E2
FSH
+
aromatizasyon
İki hücre , iki
hormon teorisi
EEEErkenrkenrkenrken fol.fol.fol.fol. fazfazfazfaz
2. 02.12.2016
2
Teka hücresi
17-OH P A4
LH
+
P4
Pato-fizyoloji
Granuloza hücresi
E2
FSH
+
aromatizasyon
LH
+
GeçGeçGeçGeç fol.fol.fol.fol. fazfazfazfaz
Folikül >13mm
İki hücre , iki
hormon teorisi
5. 02.12.2016
5
Ovulation induction with a starting dose of 50 IU of recombinant follicle
stimulating hormone in WHO group II anovulatory women: the IO-50 study, a
prospective, observational, multicentre, open trial
Joaquim Calaf Alsina, 2003
13. 02.12.2016
13
Anovulatuar DSÖ II -KS vs FSH
• KS ile klinik gebelik üç siklus boyunca %33, 41
ve %26, FSH ile ilk siklusta %52.6 ve ikinci
siklusta %35.5.
• İlk siklusun sonunda gebelik oranı FSH ile OI
sonrası %30, KS ile OI %14.6 ( 95% CI 5.3–
25.8, P < 0.003).
• İlk iki siklus sonunda gebelik oranı FSH ile OI
sonrası %50.7%, KS ile OI %32.5 ( P <0.003).
• İlk üç siklus toplam gebelik oranı KS için
%41.2, FSH için %52.1 (P < 0.021).
• Üç siklus sonrası topla canlı doğum oranı KS
için %36.9, FSH için %47.4 (P < 0.031).
100 IU75 IU50 IU 125 IU
PKOS- KS vs Gnd
27. 02.12.2016
27
Eve götürülecek mesajlar -1
1. LH aktivitesi küçük foliküllerde atreziye neden olur
2. LH ile artmış oosit kalitesi – direk olmayan kanıt
3. LH aktivitesi foliküllerden östrojen yapımını arttırır
4. LH aktivitesi hastaları prematür progesteron
yükselmelerinden koruyabilir
Eve götürülecek mesajlar -2
1. rLH serum östradiolü arttırır
2. rLH ovaryen stimulasyon için gereken rFSH dozunu
azaltır
3. rLH 35 yaş ve üzerinde implantasyon ve klinik gebeliği
arttırır
4. rLH düşük ovaryen cevabı olanlarda canlı doğumu
arttırır
28. 02.12.2016
28
Eve götürülecek mesajlar -3
1. hCG LH etkisini sağlamak için kullanılabilir
2. Günde 50-200 IU uygun hCG dozudur
3. hCG eklenmesi FSH gerekesinimini azaltır
4. Önde giden folikül 12-14 mm iken hCG eklenmesi
klinik gebeliği arttırır
Eve götürülecek mesajlar -4
• Gonadotropin ile OI endikasyonları ;
– hipogonadotropik hipogonadism
– Klomifen –dirençli PKOS’tur.
• Anovulatuar kadınlarda tedavinin amacı;
– mono-ovulasyon sağlamaktır.
• Açıklanamayan veya hafif erkek faktörü infertilitesi
olan ovulatuar kadınlarda etkin tedavi;
– KOH + IUI dır.
• Gonadotropinlerin birbirine üstünlüğü yoktur ve
uriner veya rekombinant formlar benzer etkinliktedir
29. 02.12.2016
29
Eve götürülecek mesajlar -5
• HH olan kadınlarda küçük miktarda eksojen LH
optimal folikül gelişimi için gereklidir.
– Step-up rejimi bu grupta kullanılan tedavi protokolüdür
• PKOS olan kadınlarda ,
– Kronik düşük-doz step-up protokolü tercih edilir.
• Kesin iptal kriterleri ile yakın monitorizasyon
önerilmektedir
Eve götürülecek mesajlar -6
Çoğul Gebelik önlemek
I. İlk sikluslarda minimal stimulasyon
hMG başlamadan önce 3 siklus KS kullanılmalı
KS yerine tamoksifen veya aromataz inhibitörü (letrozole) kullanılmalı*
Minimal stimulasyon <75 IU hMG veya FSH ile başlanmalı
Stimulasyona siklusun 7. veya dominat folikül seçildikten sonra başlanmalı (≥10
mm) *
Geç proliferatif fazda FSH yerine hMG , veya hCG ya da rLH eklenmeli *
II. Çok fazla folikülün veya yüksek östrojen kons. olduğu sikluslar iptal
edilmeli
III. İptal yerine alternatifler
Fazla foliküllerin aspirasyonu *
IVF döndürme