1) The document provides practical tips for monitoring an IUI cycle through ultrasound, including evaluating follicle growth, endometrial thickness, and Doppler flow to time ovulation and insemination.
2) Serial transvaginal ultrasound from days 7-8 is the standard monitoring method to track the morphological development of follicles and adjust medication doses as needed.
3) Key ultrasound indicators of follicle and endometrial maturity that determine the optimal time for a hormone trigger or IUI are a leading follicle 18-20mm in size and a triple-line endometrium 8-12mm thick.
4) Doppler ultrasound of blood flow in the follicles, uterus, and corpus luteum provides additional information on
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 .
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
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 .
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
Ovulation was initially monitored by conventional methods like BBT, mid luteal serum progesterone and urinary LH.
Nowadays, USG is used for follicular monitoring for both natural and stimulated cycles.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
Ovulation was initially monitored by conventional methods like BBT, mid luteal serum progesterone and urinary LH.
Nowadays, USG is used for follicular monitoring for both natural and stimulated cycles.
This describes the ultrasound findings in various types of ectopic pregnancies. This also goes on to integrate Beta hCG into the diagnostic algorithm of ectopic pregnancy. The lecture also briefly introduces the use of progesterone levels in the diagnostic work-up of ectopic pregnancy.
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
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
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
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Practical tips for monitoring of an iui cycle Dr. Jyoti Agarwal
1. Practical tips for monitoring
of an IUI cycle
Dr. Jyoti Agarwal
Alumini of Lady Harding Medical College
Presently Director of :- Lifecare Centre
: - Lifecare IVF
- Consultant : Pushpanjali Crosslay Hospital
- Secretary of East Delhi Gynaecologist Forum
- Treasurer Delhi Gynaecologist Forum
- Member of WOW India
- Special interest in Infertility & Ultrasound
2. Introduction
• Ovulation induction though sounds simple but
there are many obstacles ,
as each patient behaves in a different fashion.
Variety of drugs and protocols are available.
• Every center has its own pattern of COH
but the basic concept of monitoring
remains the same.
4. “Vision is the art of seeing invisible ”
Jonathan swift
• It is difficult to think of managing an infertile
couple without resorting to this versatile and
easy to use technology.
• All the modalities of ultrasound ranging from
basic black and white to the most complex ,
real time 3 – D and colour doppler have a role
to play in managing these infertile patients .
5. Five Reasons To Monitor
To evaluate if the dose being used is optimal
To adjust the dose of the drug as some patients
are hyper responsive and some are poor
responders.
To find the optimal time for inducing ovulation
To time IUI
To avoid excessive stimulation , to prevent OHSS
and multiple pregnancy
All patients to be monitored
7. How to monitor ?
•
•
•
•
•
BY E 2 ALONE
BY ULTRASOUND ALONE
BY BOTH
BY COLOR POWER DOPPLER
BY OTHER HORMONES
MINIMUM MONITORING
8. Monitoring
Ultrasound states the morphological
growth of the follicles
Hormones indicates the functional
activity of the follicles
TVS is the accepted method by all
ART centers.
10. Importance of D -2 scan
TVS is performed on day 2 of the cycle to see for
•
•
•
•
Antral follicle count
To rule out any cyst.( > 3 cm)
Endometrial shedding
Or any other pelvic pathology
We expect normal sized ovaries with very small follicles
(3—5 mm in diameter)
Follicles are of clinical importance only when their
size is 10 mm
Follicular size is measured by taking mean of 2 or 3
largest perpendicular diameters of each follicle .
11. Ultrasound follicular
monitoring
Serial USG follicular monitoring is started from
day 7 or 8 of the cycle
But in case of gonadotrophins we start scanning
from 6th day of stimulation.
12. Assessing the follicular maturity
• The follicles normally grow at a rate of
2- 3 mm / day in a stimulated cycle.
• Definitive size of the follicle which
confirms the maturity of oocytes is still
controversial.
• A follicle measuring 18—20 mm has
been found to contain a mature oocyte.
13. Corelation with serum
oestradiol levels
• Plasma estradiol levels correlates
closely with the stage of development of
the dominant follicle
• Serum estradiol levels >200 pg / ml on
day 8 of stimulation indicates adequate
dose of gonadotropins.
Ultrasound monitoring has totally
replaced estradiol monitoring in most
centers.
14. Predicting the risk of OHSS
If there are
more than 4 follicles larger than 16 mm
or more than 8 follicles larger than 12 mm
It is best not to give hCG so as to prevent
OHSS and high order multiple births.
In case of doubt do serum estradiol levels
Estradiol levels of > 1500 – 2000 pg/ml
indicates risk of OHSS and is advisable to
withhold hCG trigger.
15. Follicular doppler flow studies
• A mature follicle shows
vascularity in atleast ¾
th of the follicular
circumference &
• PSV is 10 cm/sec.
• At this time LH surge
starts and
• This is the right time to
give hCG trigger
16. Interpretation of ovarian indices
• Rising PSV & steady low RI suggests follicle is
close to rupture
• Decreasing PSV & rising RI suggests follicle is
likely to become LUF.
• Fertilisation of a follicle with PSV of less than
10 cm /sec may result in an embryo with
chromosomal abnormality.
20. Endocrine implantation
ET – 8 – 14 mm
BEST ENDOMETRIUM ON THE DAY OF HCG TRIGGER
ET > 16 mm or < 7mm
Is not associated with good prognosis
21. •
•
•
•
Proliferative phase : 4- 7 mm
Periovulatory period : 6-10 mm
Secretory phase
: 8-12 mm
Postmenopausal pd. : < 4 mm
Thickest part of the endometrium should
be measured
24. D-7 onwards
• Proliferative
endometrium
continues to grow in
size and thickens
and is seen as a
triple layer or triple
line.
• Middle layer
echogenic—Lumen
• Hypoechoic area
surrounding the
lumen—
Endometrium
functionalism
• Hyperechoic ring
outside—
Endometrium
25. In Periovulatory Phase
characteristic changes start only 24 hrs post
ovulation.
Triple line progressively becomes thicker, homogenous
and hyperechoic
33. Uterine Artery Doppler
The chance for
pregnancy is
almost zero if the PI
is more than 3.019
on the day of hCG
administration
Patients who get
pregnant have a lower
RI (0.53 vs 0.64)
34. Doppler study for uterine
receptivity
Uterine artery RI 0.60 – 0.80
PI 2.22 –3.16
No pregnancy if
VI < 1.0,
FI < 31 and
VFI < 0.25
Smoking is associated with significantly lower VI and VFI.
35. Subendometrial Vascularisation
• Presence of
subendometrial flow
is an indicator of
good endometrial
receptivity
•
If pregnancy occurs in
patients with absent
subendometrial flow
more than half of these
pregnancies will result in
abortion
36. 3 D power doppler for
endometrial receptivity
• Endometrial volume is a more reliable
parameter than endometrial thickness
• Favourable endometrial volume is 4.28 –
1.9 ml.
• No pregnancy occurred if endometrial
volume is <1 ml.
• 3D tells us also about global vascularity
of the endometrium
38. Application of 3 D us for
follicular assessment
• Cumulus may be seen
in almost 90 % of the
follicles using 3 D usg
rendering. Where as it
is seen only in 25 % of
follicles by 2D usg.
• On the day of hCG if
cumulus is not seen in
all the three planes by
3D usg , it is less likely
to be mature follicle.
Infolding of inner cell mass
of granulosa layers
40. Ovulation trigger
The end point of any ovulation induction
protocol is to indentify the best time for
triggering ovulation.
most crucial step
In a gonadotrophin
In clomiphene
Leading follicle is
18 – 20 mm in diameter.
Leading follicle is
20 – 22 mm in size
41. Ovulation to be confirmed by
• Disappearance of the follicle
• Presence of free fluid in the cul-de-sac.
• Presence of hyperechoic , smooth
secretary endometrium.
42. Timing of insemination
IUI is done 24 hrs. after LH surge is
detected
IUI is done 36 - 38 hrs. after hCG
injection
43. serum progesterone and
implantation
• Periovulatory progesterone levels are
used as a predictor of outcome.
• Elevated levels of serum progesterone in
the late follicular phase is associated
with diminshed chances of conception.
44. Premature LH surge
• Premature LH surge is known to occur in
approx 15-25 % of patients once the
leading follicle is 16 mm.
• Urinary LH kits are available to detect LH
surge.
A blood level of >10 IU /L correlates with the LH surge
45. Premature LH surge
• If an LH surge is detected , injection hCG
is given immediately.
• The hCG injection is required to
supplement the LH secreted by the body
as it is not adequate enough to induce
the final maturational changes in all the
follicles .
• IUI is done 24 hrs after the LH surge
46. Luteal phase scan
• A healthy corpus luteum shows a good
vascular ring on colour doppler
• RI of 0.35 – 0.50
• PI of 0.70 – 0.80
• PSV of 10 – 15 cm / sec.
• RI of corpus luteum corelates well with
plasma progesterone level which is an
index of luteal function.
47. To conclude
“ In the hands of experienced
operators , ultrasound and
ultrasound alone suffices for cycle
monitoring , with no necessity for
additional hormonal estimations.”
NEED OF EXTENSIVE HORMONAL
MONITORING IS NO LONGER NEEDED
48. All The Best to all of you to
design your own Minimal
Monitoring Protocol
THANK YOU FOR HEARING ME OUT