ovarian stimulation- back to basics
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This document discusses various aspects of ovarian stimulation for infertility treatment. It provides an overview of infertility facts and causes, methods for assessing ovarian reserve, and different protocols for ovarian stimulation including clomiphene, letrozole, and gonadotropins. It also discusses indications for and outcomes of ovarian stimulation combined with intrauterine insemination.
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ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
This document discusses different methods for endometrial preparation in frozen embryo transfer (FET) cycles. It describes natural cycle FET, which can be done through a true natural cycle or modified natural cycle with an HCG trigger. It also outlines artificial/hormone replacement cycle FET, where estrogen and progesterone are administered without GnRH agonists in patients with remaining ovarian function. The key points are that the endometrium must be adequately prepared prior to embryo transfer, and the age of the embryos after thawing should correspond to the developmental age of the endometrium. The best method varies between patients and there is no clear consensus.
what is new in controlled ovarian stimulation?
This document discusses new developments in controlled ovarian stimulation (COS) protocols. It outlines several new forms of fertility drugs including long acting FSH, FSH biosimilars, and subcutaneous progestagens. It also describes new COS protocols such as those using fewer injections, flexibility in start dates, dual stimulation, and individualizing FSH dosing to prevent ovarian hyperstimulation syndrome. The document concludes that while further research is still needed, these new drugs and protocols provide valuable options for increasing flexibility and optimizing outcomes in ART treatment.
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Intrauterine insemination (IUI) is a procedure in which processed and concentrated motile sperm are placed directly into the uterine cavity.
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This document discusses different methods for endometrial preparation in frozen embryo transfer cycles. It summarizes that:
1) Natural cycles can be used for younger patients but have limitations like irregular cycles and difficulty timing ovulation.
2) Hormonally controlled cycles using estrogen and progesterone with or without GnRH agonists are effective options. Exogenous hormone administration without GnRH agonists is now commonly used as it is simple and effective.
3) Factors like embryo quality and endometrial thickness predict success, but preparation method, hormone type/administration, and cryostorage length do not affect outcomes. The best predictors are good quality embryos and a tri-laminar endometrial pattern.
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...
This document discusses optimizing success with intrauterine insemination (IUI). It lists male and female factors that can indicate IUI, including issues like retrograde ejaculation or cervical hostility. Standard protocols for IUI are discussed, including using clomiphene, gonadotropins, or a combination. The timing of hCG administration and IUI is outlined. Techniques for sperm preparation and factors affecting IUI success rates are also summarized. Limitations of IUI are noted.
Thin Endometrium
This document provides guidelines for the management of thin endometrium based on evidence from studies. It discusses measurement of endometrial thickness, incidence of thin endometrium, potential causes, and impact on treatment outcomes. For ovarian stimulation cycles, fresh embryo transfers, and frozen embryo transfers, it examines the evidence and provides recommendations regarding counseling patients, elective cryopreservation, and use of adjuvants to improve outcomes for those with thin endometrium. However, it finds that currently there is limited evidence to support specific protocols or treatments for improving pregnancy rates.
Luteal phase support in ART
The document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. It notes that abnormal luteal function can occur after controlled ovarian stimulation, necessitating LPS. It reviews various LPS options including human chorionic gonadotropin and progesterone administered via different routes. Vaginal progesterone is found to effectively increase endometrial levels while intramuscular progesterone yields the highest serum levels. The document concludes that LPS is necessary to optimize ART outcomes and that intramuscular or vaginal progesterone are equally effective options.
Adjuncts in IVF laboratory: Current evidence
This document summarizes several adjunct techniques used in IVF laboratories including sperm DNA fragmentation testing, advanced sperm selection methods like IMSI and pICSI, embryo selection techniques like time-lapse imaging and PGS, and mitochondrial DNA load measurement. It reviews the current evidence for each technique, noting that while some like TL imaging show promise, the evidence is still limited and inconclusive for many techniques to recommend their routine use to improve IVF outcomes. Larger randomized controlled trials are still needed to prove effectiveness.
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This document discusses different methods for endometrial preparation in frozen embryo transfer (FET) cycles. It describes natural cycle FET, which can be done through a true natural cycle or modified natural cycle with an HCG trigger. It also outlines artificial/hormone replacement cycle FET, where estrogen and progesterone are administered without GnRH agonists in patients with remaining ovarian function. The key points are that the endometrium must be adequately prepared prior to embryo transfer, and the age of the embryos after thawing should correspond to the developmental age of the endometrium. The best method varies between patients and there is no clear consensus.
what is new in controlled ovarian stimulation?
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Intrauterine insemination (IUI) is a procedure in which processed and concentrated motile sperm are placed directly into the uterine cavity.
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This document discusses different methods for endometrial preparation in frozen embryo transfer cycles. It summarizes that:
1) Natural cycles can be used for younger patients but have limitations like irregular cycles and difficulty timing ovulation.
2) Hormonally controlled cycles using estrogen and progesterone with or without GnRH agonists are effective options. Exogenous hormone administration without GnRH agonists is now commonly used as it is simple and effective.
3) Factors like embryo quality and endometrial thickness predict success, but preparation method, hormone type/administration, and cryostorage length do not affect outcomes. The best predictors are good quality embryos and a tri-laminar endometrial pattern.
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...
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Thin Endometrium
This document provides guidelines for the management of thin endometrium based on evidence from studies. It discusses measurement of endometrial thickness, incidence of thin endometrium, potential causes, and impact on treatment outcomes. For ovarian stimulation cycles, fresh embryo transfers, and frozen embryo transfers, it examines the evidence and provides recommendations regarding counseling patients, elective cryopreservation, and use of adjuvants to improve outcomes for those with thin endometrium. However, it finds that currently there is limited evidence to support specific protocols or treatments for improving pregnancy rates.
Luteal phase support in ART
The document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. It notes that abnormal luteal function can occur after controlled ovarian stimulation, necessitating LPS. It reviews various LPS options including human chorionic gonadotropin and progesterone administered via different routes. Vaginal progesterone is found to effectively increase endometrial levels while intramuscular progesterone yields the highest serum levels. The document concludes that LPS is necessary to optimize ART outcomes and that intramuscular or vaginal progesterone are equally effective options.
Adjuncts in IVF laboratory: Current evidence
This document summarizes several adjunct techniques used in IVF laboratories including sperm DNA fragmentation testing, advanced sperm selection methods like IMSI and pICSI, embryo selection techniques like time-lapse imaging and PGS, and mitochondrial DNA load measurement. It reviews the current evidence for each technique, noting that while some like TL imaging show promise, the evidence is still limited and inconclusive for many techniques to recommend their routine use to improve IVF outcomes. Larger randomized controlled trials are still needed to prove effectiveness.
Monitoring ART cycle Aboubakr Elnashar
This document discusses monitoring of the ART (assisted reproductive technology) cycle. It describes various methods for monitoring, including ultrasound to measure follicle growth and endometrial thickness, as well as using ultrasound combined with serum estradiol levels. The key objectives of monitoring are outlined, such as predicting ovarian response, monitoring pituitary suppression, evaluating gonadotropin dose, preventing OHSS, determining the optimal time for hCG administration, and avoiding cycle cancellation. Indicators for when to adjust gonadotropin dosage or cancel the cycle are provided. Ultrasound is identified as the most practical monitoring method and combining it with estradiol is particularly useful for high-risk patients.
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This document discusses poor responders in IVF treatment. It defines poor responders based on the Bologna criteria as women aged 40 or older, or with another risk factor, who have produced 3 or fewer oocytes in a conventional stimulation protocol or have an abnormal ovarian reserve test. The document discusses using lower gonadotropin doses (150-450 IU) for poor responders to reduce risks while still achieving pregnancy. It also analyzes the use of long agonist versus antagonist protocols, finding the long agonist protocol may increase maturity and lower cancellation rates for expected poor responders. Finally, it presents a study showing double stimulation protocols over 4 weeks can produce twice as many oocytes and blastocysts for poor
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Individualisation of controlled ovarian stimulation
This document discusses individualizing controlled ovarian stimulation (COS) protocols based on a patient's ovarian reserve. It describes various ovarian reserve tests (ORTs) like AMH and AFC levels that can categorize patients' responses. Prediction models incorporating multiple factors are presented to anticipate poor or high responses and tailor gonadotropin starting doses. Treatment strategies for different POSEIDON patient groups aim to maximize oocyte yield, including increasing gonadotropin doses or adding medications like recombinant LH. Dual stimulation protocols within one cycle are also proposed.
Difficult Cases in IUI
This document discusses several complex cases involving intrauterine insemination (IUI). It describes patient histories, stimulation protocols, semen analysis results, and challenges that arose during IUI procedures. The panelists discuss options for each case, including risks of ovarian hyperstimulation, limitations of IUI for endometriosis patients, preventing premature ovulation, difficult insemination techniques, and using ultrasound guidance. The document provides guidance on managing risks and complications to optimize IUI success rates.
Luteal Phase Support
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
Management of Poor Responders
The document discusses management strategies for poor responders undergoing assisted reproductive technology. It begins by defining poor responders according to the Bologna criteria and shows how live birth rates decrease significantly with fewer oocytes retrieved. It then outlines an approach to managing poor responders that includes identifying at-risk patients using biomarkers like AMH, individualizing controlled ovarian stimulation protocols, optimizing lab procedures, and tailoring embryo transfer. Specific strategies discussed include using gonadotropins like recombinant FSH, adding LH supplementation, antagonist protocols, and minimal stimulation approaches.
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This presentation discusses controlled ovarian hyperstimulation (COH) for patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). COH is challenging for PCOS patients due to an initial poor response followed by an exaggerated response, putting them at high risk for ovarian hyperstimulation syndrome (OHSS). The presentation recommends individualizing COH protocols based on a patient's risk factors to optimize egg retrieval while avoiding OHSS complications. GnRH antagonist protocols are preferred over agonists as they allow for GnRH agonist triggering to prevent OHSS in high responders. Careful monitoring and strategies like coasting or cryopreservation can further reduce OHSS risks for PCOS patients undergoing CO
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Empty follicle syndrome is a complication where mature follicles fail to yield oocytes during egg retrieval despite optimal stimulation and triggering. It can be genuine, with no clear cause, or false due to issues with the hCG trigger shot. Risk factors include advanced age, infertility duration, and low ovarian reserve. Treatment of false EFS involves re-administering hCG and repeating retrieval after 36 hours. Prognosis is generally good except for recurrent cases. Ongoing research aims to better understand the mechanisms and identify prevention strategies.
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This document provides biographical information on Prof. Narendra Malhotra, including his professional designations, affiliations, awards, publications, special interests, and tests for ovarian reserve. He is a professor, past president of several medical organizations, managing director of health care companies, and director of IVF clinics. He has authored or edited numerous medical publications on gynecology and obstetrics. His special research interests include high risk obstetrics, ultrasound, assisted reproductive technology, and genetics.
Iui - newer concepts
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
The document summarizes guidelines from NICE in 2013 regarding IUI and IVF treatments. It recommends that for unexplained infertility, couples should try to conceive naturally for 2 years before being offered IVF. For IVF, it provides guidance on patient selection criteria, protocols for ovarian stimulation and embryo transfer, and factors that influence success rates. The document emphasizes protocols to prevent ovarian hyperstimulation syndrome and informed consent discussions on treatment risks and benefits.
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This document discusses the management of poor responders to ovarian stimulation. It defines poor responders according to the Bologna criteria as having two of the following: advanced age, a previous poor response, or abnormal biomarkers of ovarian reserve. It identifies various risk factors for poor response and stresses the importance of predicting response before treatment. It then discusses individualized controlled ovarian stimulation, including increasing gonadotropin doses, modifying GnRH analog protocols, using GnRH antagonists, and supplementing with growth hormone, estradiol, recombinant LH, and androgens to potentially improve outcomes for poor responders.
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This document contains information from Dr. Shashwat Jani regarding ovarian stimulation protocols for IUI. It discusses various stimulation options including clomiphene citrate, letrozole, gonadotropins, and combinations. It provides details on dosing, monitoring, and the advantages and disadvantages of different protocols. The goal of stimulation is to develop multiple follicles to improve pregnancy rates with IUI or develop a single follicle for anovulatory patients.
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This document provides information on intrauterine insemination (IUI), including prerequisites, indications, steps, and factors affecting success rates. It summarizes that IUI is a relatively simple and inexpensive fertility treatment that involves placing sperm directly into the uterus. Success rates are affected by factors like total motile sperm count, with counts over 5 million critical. Density gradient preparation is superior to swim-up for abnormal semen. DNA fragmentation levels also impact rates. Guidelines on when to consider IVF instead of further IUI cycles include age over 37, more than 4 failed cycles, severe male factors, and certain ovarian response patterns.
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This document summarizes markers of ovarian reserve and methods for testing ovarian reserve. It discusses how anti-Mullerian hormone (AMH) levels provide a better indicator of ovarian reserve than other markers, as AMH levels change least between cycles and are unaffected by other factors. AMH testing can help personalize infertility treatment by predicting response and tailoring stimulation protocols based on a patient's AMH level and ovarian reserve.
Controlled ovarian stimulation in IVF
This document discusses different types of ovarian stimulation protocols used in IVF. It begins by describing 4 main types of stimulation: natural/modified natural cycles involving little to no medication; mild stimulation involving low dose FSH/HMG; conventional stimulation using standard FSH/HMG doses; and high stimulation. It then covers the drugs used for ovarian stimulation, including gonadotropins and GnRH analogues. The rest of the document discusses specific GnRH agonist and antagonist protocols, methods of triggering ovulation including hCG and GnRH agonists, and criteria for cycle cancellation.
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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.
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EMPTY FOLLICLE SYNDROME
Empty follicle syndrome is a complication where mature follicles fail to yield oocytes during egg retrieval despite optimal stimulation and triggering. It can be genuine, with no clear cause, or false due to issues with the hCG trigger shot. Risk factors include advanced age, infertility duration, and low ovarian reserve. Treatment of false EFS involves re-administering hCG and repeating retrieval after 36 hours. Prognosis is generally good except for recurrent cases. Ongoing research aims to better understand the mechanisms and identify prevention strategies.
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This document provides biographical information on Prof. Narendra Malhotra, including his professional designations, affiliations, awards, publications, special interests, and tests for ovarian reserve. He is a professor, past president of several medical organizations, managing director of health care companies, and director of IVF clinics. He has authored or edited numerous medical publications on gynecology and obstetrics. His special research interests include high risk obstetrics, ultrasound, assisted reproductive technology, and genetics.
Iui - newer concepts
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
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This document provides information on intrauterine insemination (IUI), including prerequisites, indications, steps, and factors affecting success rates. It summarizes that IUI is a relatively simple and inexpensive fertility treatment that involves placing sperm directly into the uterus. Success rates are affected by factors like total motile sperm count, with counts over 5 million critical. Density gradient preparation is superior to swim-up for abnormal semen. DNA fragmentation levels also impact rates. Guidelines on when to consider IVF instead of further IUI cycles include age over 37, more than 4 failed cycles, severe male factors, and certain ovarian response patterns.
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This document summarizes markers of ovarian reserve and methods for testing ovarian reserve. It discusses how anti-Mullerian hormone (AMH) levels provide a better indicator of ovarian reserve than other markers, as AMH levels change least between cycles and are unaffected by other factors. AMH testing can help personalize infertility treatment by predicting response and tailoring stimulation protocols based on a patient's AMH level and ovarian reserve.
Controlled ovarian stimulation in IVF
This document discusses different types of ovarian stimulation protocols used in IVF. It begins by describing 4 main types of stimulation: natural/modified natural cycles involving little to no medication; mild stimulation involving low dose FSH/HMG; conventional stimulation using standard FSH/HMG doses; and high stimulation. It then covers the drugs used for ovarian stimulation, including gonadotropins and GnRH analogues. The rest of the document discusses specific GnRH agonist and antagonist protocols, methods of triggering ovulation including hCG and GnRH agonists, and criteria for cycle cancellation.
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ovarian stimulation- back to basics
- 1. Ovarian Stimulation Back to Basics Dr Parul Sehgal Incharge IVF, Maharaja Agrasen Infertility and ART centre Maharja Agrasen Hospital, Punjabi Bagh, New Delhi-26
- 2. Road to Infertility can be Tough and Tiring
- 3. Treatment may involve advanced infrastructure delicate hormone balancing careful handling of gametes
- 4. But in the end once inside the mothers body nature take over
- 5. END RESULT IS TRULY A NATURES GIFT
- 6. 1 +1
- 7. 1 +2
- 13. CHECK THE OVARIAN RESERVE
- 25. Stimulated with CC/Letrazole IUI Anovulation/ Irregularovulation For Better Results
- 29. Over response with ovarian stimulation for IUI
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