the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
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
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
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
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Platelet-rich plasma (PRP) has become popular as a non operative treatment option for a broad spectrum of medical disorders. There are reasonable amount of data which warrant continued research in PRP but currently its role in clinical practice is not completely defined. Prior to its use, special consent is required after an honest and open discussion with the patient as well controlled human studies are lacking
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Platelet-rich plasma (PRP) has become popular as a non operative treatment option for a broad spectrum of medical disorders. There are reasonable amount of data which warrant continued research in PRP but currently its role in clinical practice is not completely defined. Prior to its use, special consent is required after an honest and open discussion with the patient as well controlled human studies are lacking
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Workshop on Management of poor prognosis patientsMatheus Roque
In this presentation, it was discussed new concepts in stratification of low prognosis patients. It was also discussed the differences between LH and hCG, and how they can have an influence during COS.
platelet rich plasma is being used in infertility management extensively without sound evidence of its value. In this talk, we will discuss the real impact of using PRP in IVF
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
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the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
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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.
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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.
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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
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platelet rich plasma in reproductive medicine
1. 1/12/2020
1
PLATELET RICH PLASMA (PRP)
In
Reproductive Medicine: Current
Status
Prof. Aboubakr Elnashar
Benha university Hospital, Egypt
ABOUBAKR ELNASHAR
INTRODUCTION
PRP
Preparation: simple& easily performed.
Contain high concentrations of
1. Cytokines
2. Growth factors
ABOUBAKR ELNASHAR
2. 1/12/2020
2
Mechanisms of action
High concentration of growth factors: tissue
regeneration& healing.
The fibrin framework present over platelets
support the regenerative matrix: rapid
establishment of the proper morphological and molecular
configuration for wound healing
ABOUBAKR ELNASHAR
Preparation
Centrifuge at 1,200 rpm for 12 min
Upper: platelets & WBC
Intermediate thin: rich in WBC
Bottom: RBC
Centrifuged at 3,300 rpm for 7 min
ABOUBAKR ELNASHAR
3. 1/12/2020
3
Platelet activation
triggers the release of these growth factors by
thrombin
calcium chloride
collagen.
Each method influences both
physical form of PRP
amount of growth factors released
kinetics of release.
ABOUBAKR ELNASHAR
OBJECTIVE:
To review uses of PRP in reproductive medicine.
METHODS
A literature search for English articles, related to uses of
PRP in reproductive medicine, including articles published in
Pub Med.
From 2000 to october 2019
Keywords: PRP, ICSI, Endometrium, Ovary
ABOUBAKR ELNASHAR
4. 1/12/2020
4
RESULTS
21 studies
Intraovarian: 5 studies
Intrauterine: 16 studies
ABOUBAKR ELNASHAR
Indication No of
patients
Type of
study
1. Diminished ovarian reserve
Sills et al, 2018, Gynecol Endocrinol. 4
Case series
2. Poor responders
Sfakianoudis et al, 2019, Gynecol
Obstet Invest.
Farimani et al, 2019, Mol Biol Rep J
3
19
Case series
Case series
3. Premature ovarian failure
Pantos et al., 2019, Cell Transp
Sfakianoudis et al, 2018. J. Clin. Med.
3
1
Case series
Case report
Total 30
INTRA OVARIAN PRP
ABOUBAKR ELNASHAR
5. 1/12/2020
5
Intra ovarian infusion Procedure
Timing:
At the end of the periods
Minimal sedation
Injection:
under direct TVS guidance
using oocyte pick up needle (17-gauge)
Slowly& steadily. To ensure
Uniform distribution of infusion in all layers
Needle is gently retracted while injecting
3 punctures per ovary, intramedullary injection,
and diffusion in the subcortical layers.(Sfakianoudis et
al, 2018)
Amount into each ovary
2 mL
(Farimani et al, 2019)
4 ml
(Pantos et al, 2019)
5 mL
(Sills et al, 2018)
After the procedure
supine position for 10–15 min
rest for one hour.
Repeat procedure
/month for 2-3 months.ABOUBAKR ELNASHAR
6. 1/12/2020
6
1. DIMINISHED OVARIAN RESERVE
One study
Sills et al, 2018, Gynecol Endocrinol.
4 women with diminished ovarian reserve
PRP
5 mL injected into each ovary under direct TVS guidance.
Improved ovarian function in all cases
Increase AMH
Decrease FSH or both
2 months after tt.
IVF after 78 ± 22 (range = 59-110) days
retrieval of 5.3 ± 1.3 MII oocytes.ABOUBAKR ELNASHAR
2. POOR RESPONDERS
2 studies
Sfakianoudis et al, 2019, Gynecol Obstet Invest.
3 poor responders
failed IVF attempts, poor oocyte yield, and poor embryo quality.
PRP ovarian infusion
Within a 3-month interval
FSH decreased by 67.33%
AMH increased by 75.18%.
improved embryo quality.
Natural conception at 24 ws, an uncomplicated
healthy pregnancy at 17 ws and a successful live birth.
ABOUBAKR ELNASHAR
7. 1/12/2020
7
3. PREMATURE OVARIAN FAILURE
Ovarian rejuvenation
2 studies
Pantos et al., 2016, Annual Meeting of ESHRE
8 perimenopausal/ POF
PRP injected
successful ovarian rejuvenation 1–3 months after PRP tt.
All cases underwent natural IVF cycles: follicles
of 15.20±2.05 mm in diameter,
ICSI& all resulting embryos were
cryopreserved.
ABOUBAKR ELNASHAR
ABOUBAKR ELNASHAR
Proposed mechanism of
action for alteration of adult
ovarian function by
application of activated PRP
(Sills & Wood, 2019)
8. 1/12/2020
8
ABOUBAKR ELNASHAR
Proposed mechanism of action for
alteration of adult ovarian function by
application of activated PRP
(Sills & Wood, 2019)
PLT-derived growth factors
trigger or enable differentiation of
OSCs
Reduced FSH and/or
Increased AMH
consistent with improved or ‘re-
potentiated’ ovarian function.
ABOUBAKR ELNASHAR
The traditional dogma
Oocyte stores
Limited
non-renewable
No evidence for neo-oogenesis in adult monkey
Stem Cells.
(Yuan et al.,2013)
Existence of adult ovarian Germline SCs
an unlimited source of oocytes
(Hanna et al; 2014)
potential roles in infertility TT&fertility preservation
(Dunlop et al,2013)
Female mice lack adult germ-line stem cells
Transformation of somatic cells into stem cell-like
cells under specific in vitro conditions
(Lee et al,2013)
9. 1/12/2020
9
Comment
Number of studies: Few
Number of patients: Few
Type of studies: all case series, or case report,
No RCT
Journal of publication:
Cl Med
Gyn Endocr
Cell transplantation
Experimental
ABOUBAKR ELNASHAR
Indication No of
patients
Type of
study
1. Thin endometrium
Chang et al.;2015, Int J Clin Exp Med.
Colombo et al.,2017,J Biol Regul Homeost Agents
Zadehmodarres et al., 2017, JBRA Assist Reprod
Tandulwadkar et al, 2017,J Hum Reprod Sci
Wang et al, 2018, J Cell Biochem
Kim et al, 2019, Front Endocrinol
Chang et al, 2019, Medicine
Li et al, 2017, ESHRE annual meeting
Eftekhar et al, 2018, Taiwan J Obstet Gynecol.
Nazari et al, 2019, Int J Reprod Biomed
5
8
10
68
20
22
60
42
40
30
Case series
Case series
Case series
Case series
Case series
Case series
Case series
RCT
RCT 102
RCT
Total 245
Intrauterine PRP
10 studies
ABOUBAKR ELNASHAR
10. 1/12/2020
10
Intrauterine infusion procedure
Using IU catheter
Amount:
0.5-1 ml
(Aghajanova et al, 2018)
0.7ml
(Dieamant 2019 )
How many times:
2 or 3 times in the same cycle
ABOUBAKR ELNASHAR
Timing:
D10 of HRT cycle& repeat after 72 h: if EnT still <7 mm
(Chang et al.;2015, Li et al, 2017)
D11-12 of HRT cycle& repeat after 48 h
(Nazari et al, 2019)
D13 of HRT cycle& repeat after 48 h
(Eftechar et al, 2018)
ET
24 hr after final infusion
(Farimani et al, 2017)
72 hr after the final infusion
(Kim et al, 2019) ABOUBAKR ELNASHAR
11. 1/12/2020
11
Li et al, 2017: ESHRE annual meeting 2017: RCT
PRP group
42 cycles
Control group
51 cycles
EnT(mm) 7.7±0.2 6.5±0.3
Cancellation rate (%) 19 41
IR (%) 28 12
CPR (%) 44 20
PRP for thin endometrium improved
Endometrium proliferation
Implantation rate
CPR
ABOUBAKR ELNASHAR
Comment
Number of studies: 10
Number of patients: 245
Type of studies: all are case series, only 3 RCC
(102 patients)
Results: promising
PRP may be effective in improving endometrial
growth& possibly pregnancy outcomes in women with
thin endometrium.
More RCT are required to confirm efficacy
ABOUBAKR ELNASHAR
12. 1/12/2020
12
Indication No of
patients
Type of
study
2. Repeated implantation failure
Farimani et al, 2017, Int J Reprod Biomed
Nazari et al., 2016, Int J Reprod Biomed
Mehrafza et al, 2019, J Rep Inf
Coksuer et al, 2019, Gynecol Endocrinol
1
20
60
34
Case report
Case series
Case series
Case series
Total 135
ABOUBAKR ELNASHAR
Nazari et al., 2016, Int J Reprod Biomed (Yazd)
20 with a history of RIF
younger than 40 years
BMI below 30 kg/m2.
16 (80%) CPR
PRP was effective in improving pregnancy
outcomes in RIF.
ABOUBAKR ELNASHAR
13. 1/12/2020
13
Indication No of
patients
Type of
study
3. Chronic endometritis
Sfakianoudis et al, 2019, In Vivo 1 Case report
4. Asherman syndrome.
Aghajanova et al, 2018, Fert Ster. 7 RCT
ABOUBAKR ELNASHAR
In RIF due to persistent CHRONIC ENDOMETRITIS
(CE): (Sfakianoudis et al, 2019, In Vivo)
IU PRP& subsequent ET:
No signs of CE
Twin pregnancy.
PRP may be employed as a first-line treatment of
CE, especially for patients who fail to respond to
antibiotic.
ABOUBAKR ELNASHAR
14. 1/12/2020
14
PRP in ASHERMAN SYNDROME (AS)
combined with standard surgical& medical tt
significant increase in EnT
a feasible& promising experimental tool in
management of AS.
ABOUBAKR ELNASHAR
CONCLUSION
PRP
An innovative therapeutic modality
Affordable, simple, easily performed.
Intraovarian PRP
Diminished ovarian reserve
Poor ovarian response experimental
Premature ovarian failure
ABOUBAKR ELNASHAR
15. 1/12/2020
15
Intrauterine PRP
Thin endometrium:
promising & more RCT are required
RIF
CE experimental
AS
ABOUBAKR ELNASHAR
There is a need for
1. Research on cellular& molecular level to improve
our knowledge on PRP mode of action
2. Standardization of PRP
1. Preparation methods
2. Application methods
3. Well-designed, large RCT to confirm its efficacy
&safety
Without strong, unbiased evidence, any
intervention is a suspect until proven otherwise.ABOUBAKR ELNASHAR
16. 1/12/2020
16
You can get this lecture and 446 lecture from:
1.My scientific page on Face book: Aboubakr
Elnashar Lectures.
https://www.facebook.com/groups/2277448840913
51/
2.Slide share web site
3. elnashar53@hotmail.com
4.My clinic: Althwara st, Mansura, Egypt
ABOUBAKR ELNASHAR