how to determine your patient chance of having spontaneous pregnancy? how to evaluate chance of success of IVF ? it should be based on objective way. this talk may help to illustrate this
CONTROVERSIES in INDUCTION OF LABOR Dr. Dipti Nabh , Dr. Sharda Jain Lifecare Centre
GRAND MULTIPARA
FIGO definition - GM taken as delivery of 5th to 9th Infant, 10th and above taken as great GM
Prevalence - Gulf countries and African sub-continent
Risks with increasing parity -
Maternal
Dysfunction labor
Uterine rupture
Morbid adherence of placenta
Unstable lie & presentation
Precipitate deliveries
UV Prolapse
Medical condition due to increasing age
Fetal
1 Low APGAR score
2 Meconium aspiration syndrome
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.
1. Prognostic models can help predict the chances of conceiving naturally, conceiving with interventions like IUI or IVF, and the chances of live birth from IVF.
2. Key factors in these models include female age, duration of infertility, cause of infertility, ovarian reserve tests, and data from previous treatment cycles.
3. Existing prediction models have been shown to have good discrimination and calibration for outcomes like IUI or IVF success, though individual patient preferences must also be considered in treatment decisions.
Intrauterine insemination (IUI) is a laboratory procedure where fast moving sperms are separated from more sluggish or non-moving sperms. The fast moving sperms are then placed into the woman’s womb at the time of ovulation (when egg is released) .
IUI with or without fertility drugs / injections (clomiphene / gonadotrophins) – as IUI can be given with or without fertility drugs to boost egg production.
This document provides guidelines for the induction of labor and management of certain complications during labor and delivery. It addresses indications for induction, recommended methods, monitoring requirements, management of failed induction, and special considerations for breech presentation and intrauterine fetal death. Factors regarding unfavorable breech delivery and contraindications are also outlined.
This document summarizes a panel discussion on the management of IVF pregnancies conducted by Delhi ISAR, Advance Fertility and Gynaecology Centre, and Madhukar Rainbow Group of Hospitals. The panelists provided expert opinions on topics like the choice of ART treatment, number of embryos to transfer, luteal phase support, anomaly screening, reduction of higher order multiples, antenatal follow-up, prevention of preterm labor, use of antenatal steroids, and delivery timing in twin pregnancies. The document emphasizes that IVF pregnancies require special care and management.
Ahmed Walid Anwar Morad, Professor Obstetrics and Gynecology
Optional procedures alongside the standard IVF protocol to increase the chance of a live birth.
CONTROVERSIES in INDUCTION OF LABOR Dr. Dipti Nabh , Dr. Sharda Jain Lifecare Centre
GRAND MULTIPARA
FIGO definition - GM taken as delivery of 5th to 9th Infant, 10th and above taken as great GM
Prevalence - Gulf countries and African sub-continent
Risks with increasing parity -
Maternal
Dysfunction labor
Uterine rupture
Morbid adherence of placenta
Unstable lie & presentation
Precipitate deliveries
UV Prolapse
Medical condition due to increasing age
Fetal
1 Low APGAR score
2 Meconium aspiration syndrome
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.
1. Prognostic models can help predict the chances of conceiving naturally, conceiving with interventions like IUI or IVF, and the chances of live birth from IVF.
2. Key factors in these models include female age, duration of infertility, cause of infertility, ovarian reserve tests, and data from previous treatment cycles.
3. Existing prediction models have been shown to have good discrimination and calibration for outcomes like IUI or IVF success, though individual patient preferences must also be considered in treatment decisions.
Intrauterine insemination (IUI) is a laboratory procedure where fast moving sperms are separated from more sluggish or non-moving sperms. The fast moving sperms are then placed into the woman’s womb at the time of ovulation (when egg is released) .
IUI with or without fertility drugs / injections (clomiphene / gonadotrophins) – as IUI can be given with or without fertility drugs to boost egg production.
This document provides guidelines for the induction of labor and management of certain complications during labor and delivery. It addresses indications for induction, recommended methods, monitoring requirements, management of failed induction, and special considerations for breech presentation and intrauterine fetal death. Factors regarding unfavorable breech delivery and contraindications are also outlined.
This document summarizes a panel discussion on the management of IVF pregnancies conducted by Delhi ISAR, Advance Fertility and Gynaecology Centre, and Madhukar Rainbow Group of Hospitals. The panelists provided expert opinions on topics like the choice of ART treatment, number of embryos to transfer, luteal phase support, anomaly screening, reduction of higher order multiples, antenatal follow-up, prevention of preterm labor, use of antenatal steroids, and delivery timing in twin pregnancies. The document emphasizes that IVF pregnancies require special care and management.
Ahmed Walid Anwar Morad, Professor Obstetrics and Gynecology
Optional procedures alongside the standard IVF protocol to increase the chance of a live birth.
Free Information Session 5th September 2012: Recent Breakthroughs in IVFFertility SA
This document summarizes new directions in in vitro fertilization (IVF) being explored at FertilitySA to address common problems experienced by couples. These include using growth hormone to increase egg yield for those with low ovarian reserve, selecting sperm for ICSI based on hyaluron receptors, preimplantation genetic testing to identify genetic problems, endometrial biopsies to improve implantation, and culturing embryos in media containing GM-CSF to help with recurrent miscarriage. Ongoing trials are exploring the use of corifollitropin alfa to reduce injections and improve outcomes. The overall aim is to continue improving treatment through research and providing individualized care.
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...Lifecare Centre
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.
This document discusses reasons why IVF cycles may fail and provides guidance on learning from failed cycles. It defines recurrent IVF failure and recurrent implantation failure. Common causes of failure discussed include embryo quality, endometrial factors, and uterine issues like polyps or hydrosalpinx. Investigations like hysteroscopy and salpingectomy are recommended to address correctable causes. Other potential factors explored are endometrial thickness, scratching, and refractory endometrium. The goal is to identify avoidable causes and improve outcomes in subsequent cycles.
How to prevent occurrence of severe ovarian hyperstimulation in IVF. Is there a way ? this talk will present a pilot randomised study that may shed the light on this
A failed IVF cycle can be because of poor egg quality, sperm quality or uterine lining. It is assumed that all the stimulation egg pick up, laboratory procedures and embryo transfers have been done meticulously in previous attempts. We offer certain modifications in an IVF cycles for optimizing outcome in couples suffering from failed IVF attempts-
Optimized stimulation protocol: The short antagonist protocol offers the best results in terms of selection of the best oocytes (eggs) in most cases.
Selection of Sperm: In many cases, Intra Cytoplasmic Sperm Injection (ICSI) is offered as it has been suggested that it may improve fertilization rates and hence, overall pregnancy outcome. Our embryologist takes special care to select the best sperms for doing ICSI.
Hysteroscopy: The hysteroscope aids us in picking up uterine abnormalities which are sometimes missed at routine ultrasound e.g., small polyps. It is also useful in washing and cleaning the uterus which sometimes may help in improving the outcomes. Endometrial scratching is also done at the same setting to improve the uterine receptivity.
Intravenous Immunoglobulin (IYIg): IVIg seems to directly affect NK cell level and activity, by reducing their absolute numbers and increasing the expression of inhibitory receptors CD94 which potentially can improve pregnancy outcome.
Vitamins and Antioxidants: DHEA, L Arginine, Zinc, selenium etc. are given to women and men as indicated to improve the egg and sperm quality.
Atosiban: This is a uterine relaxant which is given during the embryo transfer. It helps in relaxing the uterus and therefore, improving the endometrial receptivity.
Laser Hatching: Laser hatching of the embryos is performed on the day of embryo transfer to ensure that the shell of the embryo hatches easily. This allows the embryo to implant better. This is mainly suitable for embryos with thick shell, advanced age group and frozen embryos.
ERA: ERA presumably detects the phase of the endometrium in which the embryo best implant. However, there is controversy regarding the actual benefit of this in improving the live birth rate.
PGS: PGS is a way of detecting abnormal embryos thus may help in improving the pregnancy rates. However, each case must be individualized.
Day of Transfer: Not all women will be benefitted by Blastocyst (Day 5 ) transfer as many seem to believe by studying the internet. The day of transfer should be individualized for each patient.
Meticulous Transfer Technique: Embryo transfer is the final and one of the most crucial step of IVF. All embryo transfers at AFGC are performed by Dr Kaberi Banerjee who has taken special training in embryo transfer from UK.
1. Intrauterine insemination (IUI) involves placing processed semen into the uterine cavity around ovulation and can increase conception rates for unexplained infertility compared to timed intercourse.
2. For unexplained infertility, IUI with or without ovarian stimulation is a first-line treatment option that is simple, cost-effective and less invasive than IVF.
3. Factors like younger female age, shorter infertility duration, and ovarian stimulation improve IUI success rates for unexplained infertility, with pregnancy rates ranging from 3.8-17.1% depending on treatment.
1. The document discusses new concepts in infertility including updated WHO reference values for semen analysis, the use of ICSI for male factor infertility, and success rates varying based on the cause of infertility.
2. ICSI, where surgically retrieved sperm are injected into eggs, has become an established procedure for couples with male subfertility to have a biological child, with reassuring post-natal outcomes reported so far.
3. The success of IVF depends on the type of infertility, with male factor infertility seeing live birth rates around 40% and female factor infertility around 25%, higher than other causes of infertility.
In this presentation during 4th National Conference Embriology ISAR, we discussed about the oocyte inefficiency faced by women, evaluated if there is any solution to overcome this problem, and finally suggested an alternative. All of this presenting evidence that the ovarian stimulation is not related to a decrease in embryo quality. Maximizing the number of oocytes retrieved during ovarian stimulation, is the best way to improve the cumulative live birth rates per ovarian stimulation, decreasing the number of ovarian stimulation and oocyte pick-ups necessary to achieve the mainly goal of an IVF treatment: a health live birth
This document discusses the use of letrozole for fertility treatments. It begins with an introduction and outline on polycystic ovary syndrome (PCOS), unexplained infertility, fertility preservation for breast cancer patients, frozen embryo transfer, and decreasing ovarian hyperstimulation syndrome (OHSS). It then goes into more detail on each topic, providing evidence from randomized controlled trials, meta-analyses, and clinical guidelines that letrozole results in higher pregnancy and live birth rates compared to clomiphene citrate for PCOS and unexplained infertility. It also discusses how letrozole can be used during fertility preservation for breast cancer patients to prevent high estrogen levels. The document concludes by stating letrozole may
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...DR SHASHWAT JANI
Dr. Shashwat Jani is a consultant assistant professor in Ahmedabad, India who specializes in infertility treatment. The document discusses various factors related to infertility, treatments for different conditions, and guidelines for selecting patients for assisted reproductive technologies (ART) like in vitro fertilization (IVF). It covers female factors like tubal and uterine issues, ovarian problems, and endometriosis; male factors such as semen abnormalities; and treatments for different types of infertility including IUI, IVF, ICSI, and use of donor gametes.
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
This document provides information on intrauterine insemination (IUI), including definitions, rationale, indications, contraindications, procedures, and factors affecting success. IUI involves directly transferring processed semen into the uterine cavity near the time of ovulation. It is indicated for conditions like mild male factor infertility or cervical hostility. Success rates are highest when IUI is used with ovarian stimulation and when the inseminated motile sperm count is over 1 million. Precise timing of insemination relative to ovulation is important. The procedure involves sperm preparation, monitoring follicle development and the ovulation process, and then inseminating into the uterus using a catheter.
Threatened Miscarriage Verdict is out on Hormonal Treatment Dr Jyoti AgarwalLifecare Centre
- Threatened miscarriage occurs in around 15% of clinically recognized pregnancies and can cause significant emotional and psychological stress for couples.
- Multiple meta-analyses and randomized controlled trials have found that oral administration of dydrogesterone is more effective at reducing the risk of miscarriage in cases of threatened miscarriage compared to vaginal progesterone or no treatment.
- Dydrogesterone has higher bioavailability when taken orally compared to micronized progesterone, requires a lower dose, and may have immunomodulatory properties that further reduce the risk of miscarriage.
An IVF procedure involves stimulating a woman's ovaries to develop multiple eggs, retrieving the eggs, fertilizing them with sperm in a lab, then transferring embryos into the uterus. Success rates are around 40% per cycle but can be higher for younger women. Factors like egg quality, sperm quality, and uterine lining can impact success. Adjustments to protocols and additional treatments may help improve outcomes for couples experiencing failed IVF cycles. Ongoing monitoring and support continues if pregnancy is achieved through IVF.
This document summarizes guidelines for induction of labor from several sources. It discusses best practices for confirming gestational age, considering medical indications, accepting maternal request, proceeding over maternal refusal, timing of induction, and monitoring during labor induction. It also provides evidence-based recommendations on methods of induction such as membrane sweeping, cervical assessments, amniotomy, oxytocin administration, and fetal monitoring. The document synthesizes evidence from multiple systematic reviews and clinical guidelines to provide comprehensive guidance on safe and effective labor induction practices.
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
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
The document discusses recurrent implantation failure (RIF) after in vitro fertilization (IVF). RIF can be caused by factors related to the embryo, endometrium, or both. Embryo factors include poor egg or sperm quality, genetic abnormalities, or developmental issues. Endometrial factors involve uterine abnormalities, thin lining, altered receptors, or immunological incompatibility. Treatments aim to improve the embryo, such as by changing stimulation protocols, or the endometrium through hysteroscopic surgery, immunotherapy, or adjusting the transfer timing. Testing includes evaluating the embryos, endometrium, cavitary abnormalities, and immunological factors to guide personalized treatment strategies for RIF patients.
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
This document summarizes current evidence and clinical practice regarding the use of traditional Chinese medicine (TCM) for patients undergoing in vitro fertilization (IVF). It discusses several studies that found varying rates of TCM use among IVF patients and notes that use is likely underreported. The document then outlines the whole-systems TCM approach used at one center, including individualized treatment based on pattern diagnosis and the menstrual cycle phase. Key points of treatment during different IVF cycle stages are provided. Finally, the document reviews several retrospective studies that found improved live birth rates and outcomes with the integration of TCM and acupuncture for both fresh and frozen embryo transfers.
Free Information Session 5th September 2012: Recent Breakthroughs in IVFFertility SA
This document summarizes new directions in in vitro fertilization (IVF) being explored at FertilitySA to address common problems experienced by couples. These include using growth hormone to increase egg yield for those with low ovarian reserve, selecting sperm for ICSI based on hyaluron receptors, preimplantation genetic testing to identify genetic problems, endometrial biopsies to improve implantation, and culturing embryos in media containing GM-CSF to help with recurrent miscarriage. Ongoing trials are exploring the use of corifollitropin alfa to reduce injections and improve outcomes. The overall aim is to continue improving treatment through research and providing individualized care.
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...Lifecare Centre
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.
This document discusses reasons why IVF cycles may fail and provides guidance on learning from failed cycles. It defines recurrent IVF failure and recurrent implantation failure. Common causes of failure discussed include embryo quality, endometrial factors, and uterine issues like polyps or hydrosalpinx. Investigations like hysteroscopy and salpingectomy are recommended to address correctable causes. Other potential factors explored are endometrial thickness, scratching, and refractory endometrium. The goal is to identify avoidable causes and improve outcomes in subsequent cycles.
How to prevent occurrence of severe ovarian hyperstimulation in IVF. Is there a way ? this talk will present a pilot randomised study that may shed the light on this
A failed IVF cycle can be because of poor egg quality, sperm quality or uterine lining. It is assumed that all the stimulation egg pick up, laboratory procedures and embryo transfers have been done meticulously in previous attempts. We offer certain modifications in an IVF cycles for optimizing outcome in couples suffering from failed IVF attempts-
Optimized stimulation protocol: The short antagonist protocol offers the best results in terms of selection of the best oocytes (eggs) in most cases.
Selection of Sperm: In many cases, Intra Cytoplasmic Sperm Injection (ICSI) is offered as it has been suggested that it may improve fertilization rates and hence, overall pregnancy outcome. Our embryologist takes special care to select the best sperms for doing ICSI.
Hysteroscopy: The hysteroscope aids us in picking up uterine abnormalities which are sometimes missed at routine ultrasound e.g., small polyps. It is also useful in washing and cleaning the uterus which sometimes may help in improving the outcomes. Endometrial scratching is also done at the same setting to improve the uterine receptivity.
Intravenous Immunoglobulin (IYIg): IVIg seems to directly affect NK cell level and activity, by reducing their absolute numbers and increasing the expression of inhibitory receptors CD94 which potentially can improve pregnancy outcome.
Vitamins and Antioxidants: DHEA, L Arginine, Zinc, selenium etc. are given to women and men as indicated to improve the egg and sperm quality.
Atosiban: This is a uterine relaxant which is given during the embryo transfer. It helps in relaxing the uterus and therefore, improving the endometrial receptivity.
Laser Hatching: Laser hatching of the embryos is performed on the day of embryo transfer to ensure that the shell of the embryo hatches easily. This allows the embryo to implant better. This is mainly suitable for embryos with thick shell, advanced age group and frozen embryos.
ERA: ERA presumably detects the phase of the endometrium in which the embryo best implant. However, there is controversy regarding the actual benefit of this in improving the live birth rate.
PGS: PGS is a way of detecting abnormal embryos thus may help in improving the pregnancy rates. However, each case must be individualized.
Day of Transfer: Not all women will be benefitted by Blastocyst (Day 5 ) transfer as many seem to believe by studying the internet. The day of transfer should be individualized for each patient.
Meticulous Transfer Technique: Embryo transfer is the final and one of the most crucial step of IVF. All embryo transfers at AFGC are performed by Dr Kaberi Banerjee who has taken special training in embryo transfer from UK.
1. Intrauterine insemination (IUI) involves placing processed semen into the uterine cavity around ovulation and can increase conception rates for unexplained infertility compared to timed intercourse.
2. For unexplained infertility, IUI with or without ovarian stimulation is a first-line treatment option that is simple, cost-effective and less invasive than IVF.
3. Factors like younger female age, shorter infertility duration, and ovarian stimulation improve IUI success rates for unexplained infertility, with pregnancy rates ranging from 3.8-17.1% depending on treatment.
1. The document discusses new concepts in infertility including updated WHO reference values for semen analysis, the use of ICSI for male factor infertility, and success rates varying based on the cause of infertility.
2. ICSI, where surgically retrieved sperm are injected into eggs, has become an established procedure for couples with male subfertility to have a biological child, with reassuring post-natal outcomes reported so far.
3. The success of IVF depends on the type of infertility, with male factor infertility seeing live birth rates around 40% and female factor infertility around 25%, higher than other causes of infertility.
In this presentation during 4th National Conference Embriology ISAR, we discussed about the oocyte inefficiency faced by women, evaluated if there is any solution to overcome this problem, and finally suggested an alternative. All of this presenting evidence that the ovarian stimulation is not related to a decrease in embryo quality. Maximizing the number of oocytes retrieved during ovarian stimulation, is the best way to improve the cumulative live birth rates per ovarian stimulation, decreasing the number of ovarian stimulation and oocyte pick-ups necessary to achieve the mainly goal of an IVF treatment: a health live birth
This document discusses the use of letrozole for fertility treatments. It begins with an introduction and outline on polycystic ovary syndrome (PCOS), unexplained infertility, fertility preservation for breast cancer patients, frozen embryo transfer, and decreasing ovarian hyperstimulation syndrome (OHSS). It then goes into more detail on each topic, providing evidence from randomized controlled trials, meta-analyses, and clinical guidelines that letrozole results in higher pregnancy and live birth rates compared to clomiphene citrate for PCOS and unexplained infertility. It also discusses how letrozole can be used during fertility preservation for breast cancer patients to prevent high estrogen levels. The document concludes by stating letrozole may
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...DR SHASHWAT JANI
Dr. Shashwat Jani is a consultant assistant professor in Ahmedabad, India who specializes in infertility treatment. The document discusses various factors related to infertility, treatments for different conditions, and guidelines for selecting patients for assisted reproductive technologies (ART) like in vitro fertilization (IVF). It covers female factors like tubal and uterine issues, ovarian problems, and endometriosis; male factors such as semen abnormalities; and treatments for different types of infertility including IUI, IVF, ICSI, and use of donor gametes.
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
This document provides information on intrauterine insemination (IUI), including definitions, rationale, indications, contraindications, procedures, and factors affecting success. IUI involves directly transferring processed semen into the uterine cavity near the time of ovulation. It is indicated for conditions like mild male factor infertility or cervical hostility. Success rates are highest when IUI is used with ovarian stimulation and when the inseminated motile sperm count is over 1 million. Precise timing of insemination relative to ovulation is important. The procedure involves sperm preparation, monitoring follicle development and the ovulation process, and then inseminating into the uterus using a catheter.
Threatened Miscarriage Verdict is out on Hormonal Treatment Dr Jyoti AgarwalLifecare Centre
- Threatened miscarriage occurs in around 15% of clinically recognized pregnancies and can cause significant emotional and psychological stress for couples.
- Multiple meta-analyses and randomized controlled trials have found that oral administration of dydrogesterone is more effective at reducing the risk of miscarriage in cases of threatened miscarriage compared to vaginal progesterone or no treatment.
- Dydrogesterone has higher bioavailability when taken orally compared to micronized progesterone, requires a lower dose, and may have immunomodulatory properties that further reduce the risk of miscarriage.
An IVF procedure involves stimulating a woman's ovaries to develop multiple eggs, retrieving the eggs, fertilizing them with sperm in a lab, then transferring embryos into the uterus. Success rates are around 40% per cycle but can be higher for younger women. Factors like egg quality, sperm quality, and uterine lining can impact success. Adjustments to protocols and additional treatments may help improve outcomes for couples experiencing failed IVF cycles. Ongoing monitoring and support continues if pregnancy is achieved through IVF.
This document summarizes guidelines for induction of labor from several sources. It discusses best practices for confirming gestational age, considering medical indications, accepting maternal request, proceeding over maternal refusal, timing of induction, and monitoring during labor induction. It also provides evidence-based recommendations on methods of induction such as membrane sweeping, cervical assessments, amniotomy, oxytocin administration, and fetal monitoring. The document synthesizes evidence from multiple systematic reviews and clinical guidelines to provide comprehensive guidance on safe and effective labor induction practices.
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
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
The document discusses recurrent implantation failure (RIF) after in vitro fertilization (IVF). RIF can be caused by factors related to the embryo, endometrium, or both. Embryo factors include poor egg or sperm quality, genetic abnormalities, or developmental issues. Endometrial factors involve uterine abnormalities, thin lining, altered receptors, or immunological incompatibility. Treatments aim to improve the embryo, such as by changing stimulation protocols, or the endometrium through hysteroscopic surgery, immunotherapy, or adjusting the transfer timing. Testing includes evaluating the embryos, endometrium, cavitary abnormalities, and immunological factors to guide personalized treatment strategies for RIF patients.
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
This document summarizes current evidence and clinical practice regarding the use of traditional Chinese medicine (TCM) for patients undergoing in vitro fertilization (IVF). It discusses several studies that found varying rates of TCM use among IVF patients and notes that use is likely underreported. The document then outlines the whole-systems TCM approach used at one center, including individualized treatment based on pattern diagnosis and the menstrual cycle phase. Key points of treatment during different IVF cycle stages are provided. Finally, the document reviews several retrospective studies that found improved live birth rates and outcomes with the integration of TCM and acupuncture for both fresh and frozen embryo transfers.
1) The document discusses several types of IVF treatment with reduced stimulation including natural cycle IVF, modified natural cycle IVF, minimal stimulation IVF, and in-vitro maturation. These methods use lower doses of fertility drugs or no drugs at all to help reduce side effects, risks, and costs compared to conventional IVF.
2) It also discusses pre-implantation genetic screening which screens embryos for genetic abnormalities before transfer to help increase success rates, especially for older women. Techniques include biopsy of embryos followed by analysis using methods like aCGH, qPCR, or next generation sequencing.
3) Finally, the document discusses laser assisted hatching, a technique where an embryo's outer layer is
Individualized ovarian stimulation protocols in IVF (1).pptxRaju Nair
Explaining the best protocol for ivf stimulation. How we can optimize the stimulation regimen to get adequate response and there by healthy baby is a challenge
Indivisualization of Ovulation Induction - Dr Dhorepatil BharatiBharati Dhorepatil
IVF started to develop fast with the aim of maximizing pregnancy rates per cycle
Higher number of oocytes and thus more embryos
Use of unphysiological high doses of gonadotropins
Time consuming protocols
Higher costs
Patient discomfort
Higher risk of OHSS
Very high risk of multiple gestation
This document provides information about intrauterine insemination (IUI) from Dr. Anand K. Shinde, including why IUI works, why controlled ovarian hyperstimulation is used with IUI, typical success rates for IUI, contraindications for IUI, indications for IUI, possible complications of IUI, considerations around doing multiple IUI in one cycle, post-IUI support, required surveillance, and difficult situations that can arise for IUI patients.
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)Muhammad Anas Shamsi
Assisted reproductive technology (ART) is used to treat infertility. It includes fertility treatments that handle both a woman's egg and a man's sperm. It works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body. In vitro fertilization (IVF) is the most common and effective type of ART.
In Vitro Fertilization (IVF) involves stimulating a woman's ovaries to develop multiple eggs, retrieving the eggs and fertilizing them with sperm in a lab, then transferring the resulting embryo(s) into the uterus. Key aspects of IVF include controlled ovarian hyperstimulation using fertility medications, egg retrieval under ultrasound guidance, fertilization via intracytoplasmic sperm injection if needed, embryo culture until blastocyst stage, and embryo transfer into the uterus. Success rates of IVF depend on factors like the woman's age, cause of infertility, and embryo quality.
This randomized controlled trial compared the effectiveness and safety of minimal stimulation IVF (mini-IVF) to conventional IVF. 564 women were randomly assigned to either mini-IVF using oral clomiphene and gonadotropins followed by a freeze-all policy, or conventional IVF using high dose gonadotropins and fresh double embryo transfer. The primary outcome was cumulative live birth rate within 6 months, and secondary outcomes included pregnancy rates, ovarian hyperstimulation syndrome, and multiple pregnancy rates. Results showed mini-IVF resulted in comparable live birth rates but significantly lower risks of ovarian hyperstimulation syndrome and multiple pregnancies compared to conventional IVF.
Fertility treatments like IUI, IVF, and ICSI help couples conceive when natural conception is not possible by assisting the fertilization process in the body or in a lab. These treatments involve stimulating a woman's ovaries to produce multiple eggs, collecting and preparing sperm, fertilizing the eggs, culturing any resulting embryos, and transferring embryos into the uterus. While they do not guarantee pregnancy, they can increase the chances of pregnancy by helping the biological process of reproduction.
1) Cervical ripening is used to induce labor when the cervix is unfavorable (Bishop score <6) and involves using agents like prostaglandins, misoprostol, or mechanical methods to soften and dilate the cervix.
2) Oxytocin is commonly used for labor induction when the cervix is favorable but careful monitoring is needed due to risks of uterine tachysystole and changes in the fetal heart rate.
3) While prostaglandins are more effective cervical ripening agents compared to oxytocin alone, all methods have risks and more research is still needed to evaluate some traditional induction methods.
1 iui a z, including techniques of iui & lps Dr. Sharda jain & TeamLifecare Centre
This document provides information about a certificate course on IUI and stimulation. It lists the faculty members teaching the course and provides details about one of the faculty members, Dr. Abhishek Singh Parihar, including his qualifications and areas of clinical interest. It then discusses the history and process of IUI, including patient selection criteria, ovarian stimulation protocols, semen preparation techniques, the insemination procedure, and luteal phase support. It concludes by noting factors that influence the success of IUI and discussing risks and complications.
This document provides information on infertility, including definitions, causes, evaluation, and treatment of male and female factor infertility. It defines infertility as the inability to conceive after one year of unprotected intercourse. Causes of infertility can be due to male factors, female factors, or a combination of both. Evaluation of infertility involves medical history, physical exam, and diagnostic testing such as semen analysis, ovulation testing, and imaging. Treatment depends on the underlying cause but may include lifestyle changes, medication, surgery, artificial insemination, IVF, or adoption.
This document provides information on preparing couples for IVF treatment. It discusses emotional, physical and medical preparations for both male and female partners. Key aspects covered include counseling couples on the IVF process and potential risks, lifestyle changes like diet and reducing smoking/alcohol, medical testing and treating any issues found, and procedures like hysteroscopy, laparoscopy or myomectomy to improve IVF success rates. Thorough preparation of both partners is important to address their emotional needs and optimize their physical health prior to starting IVF.
This document discusses infertility evaluation and treatment. It begins by outlining factors to consider before trying to conceive and describing methods for timing intercourse. Common causes of infertility include problems with ovulation, male factor issues, and tubal or uterine abnormalities. Treatment options range from lifestyle changes to assisted reproductive technologies like intrauterine insemination, ovulation induction, and in vitro fertilization. While assisted reproduction can help many couples conceive, it may also lead to multiple births and there are still some unknown risks for children conceived through these methods.
This document discusses IVF treatment options and provides information on when IVF may be needed and the process before undergoing IVF. It explains that couples should typically try conceiving naturally for 6-12 months before considering IVF. Initial tests and treatments may include ovulation induction medications or IUI before progressing to IVF, which involves stimulating egg production, retrieving eggs, fertilizing them in vitro, and embryo transfer. The success of IVF depends on factors like age, with average success rates of 15-50%.
Infertility in male and female.pptx for Nursing studentsankitarya2550
Infertility is a condition referred to unavailability to conceive after continue one year of regular coitus without using any kind of contraceptive and family planning methodology.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
This document discusses infertility, its causes, treatments, and success rates. It notes that infertility affects 8-12% of couples worldwide and can be caused by issues with either the male or female reproductive systems in around 30% of cases each. Common treatments discussed are fertility drugs, intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). Success rates for IVF decline with the woman's age but are around 40% for those under 35. The first "test tube baby" was born in 1978 in Manchester, UK.
This document discusses various aspects of assisted reproductive technology (ART) including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). It provides information on the causes of infertility, procedures for IVF such as egg retrieval, embryo transfer, and blastocyst culture. The document also discusses who may benefit from IVF and ICSI, including those with male factor infertility issues or previous IVF failures. Other ART procedures mentioned include zygote intrafallopian transfer, gamete intrafallopian transfer, and potential future techniques like creating artificial gametes.
we need to update our knowledge regarding management of endometriosis.
Which is better: medications or surgery? let's see what can this talk tell us about
what is the efficacy of Dienogest for management of endometriosis? let's see what research can tell us
Is it better that other modalities of management?
This document outlines a 4G ovarian stimulation protocol. It discusses mono follicular versus multifollicular development in ovarian stimulation for IUI and IVF/ICSI. It also discusses luteal phase support strategies, including route of progesterone administration. Recombinant FSH, HMG, and gonadotropin dose are discussed. The document concludes by discussing a business model for an IVF center located within a hospital.
This document discusses ways to reduce miscarriage rates. It begins by outlining the agenda and introducing progesterone and NIPGT (non-invasive preimplantation genetic testing) as potential approaches. It then discusses how progesterone has immunomodulatory properties and supports the luteal phase in ART cycles. Several studies are summarized that show progesterone supplementation can reduce miscarriage rates. NIPGT is introduced as a less invasive way to assess chromosomal defects in embryos compared to traditional PGT. The document concludes that while progesterone is effective for reducing miscarriage, more evidence is still needed to determine if NIPGT could help in cases of recurrent miscarriage, especially in older patients.
This document discusses the pros and cons of transferring embryos on day 5 (blastocyst stage) versus day 3. It raises questions about whether day 5 transfer should be routine practice and whether there are any adverse effects. Specifically, it notes that day 5 transfer is not suitable for all women, especially those with a limited number of embryos, and that an increased incidence of autism has been reported. It also discusses whether day 5 transfer is practical given the infrastructure needed, and whether it is really of any value if more than one embryo is being transferred. The conclusion is that day 5 transfer should only be offered for highly selected cases.
- There is consensus that submucosal fibroids interfere with fertility and should be removed in infertile patients, regardless of size or symptoms. Subserosal fibroids do not impact fertility.
- The impact of intramural fibroids on fertility is still uncertain. Some studies show they may reduce clinical pregnancy and increase miscarriage rates, while other studies show no effect.
- The benefits of myomectomy for interstitial or intramural fibroids are unclear, as evidence is limited and conflicting. Myomectomy may be considered for failed IVF cycles or large fibroids distorting the cavity.
- There are ongoing controversies around the impact of fibroid number, location and size,
Adenomyosis is a difficult disease to diagnose due to overlapping symptoms with other conditions like fibroids. While historically considered a disease of parous women, it is increasingly being identified in nulliparous women as well. MRI is the gold standard for diagnosis but ultrasound, especially 3D ultrasound of the junctional zone, can also provide clues. Treatment depends on patient goals and includes long acting progestins, long protocol IVF to suppress symptoms during fertility treatment, and in some cases focused ultrasound or uterine sparing surgery. More research is still needed on newer minimally invasive treatments.
IVF will remain the solution for infertile couples. But its future will dramatically be directed to fertile couples !!!! This talk will discuss these issues
- Infertility is considered a disease by the WHO and most countries, so infertility treatment is allowed. Donor gametes and surrogacy are generally not permitted in Islam.
- Assisted reproduction technologies like IVF and PGD are allowed to help couples conceive, but third parties are not acceptable. Embryo research is only permitted using spare IVF embryos.
- While stem cells are being studied for conditions like premature ovarian failure, there is no evidence they can differentiate into eggs. The risks of stem cell therapy for fertility are still unclear. Cryopreservation and some new techniques also have uncertain religious rulings.
This document discusses common pitfalls in infertility management and provides recommendations to avoid them. It notes that too many unnecessary investigations should be avoided, and that semen analysis guidelines have been updated. It recommends not performing procedures like tubal insufflation, D&C, or ovarian drilling without evidence of benefit. Overstimulation during ovarian induction and inappropriate drug responses are highlighted. The use of laparoscopic power morcellation is warned against due to cancer risk. While stem cells may help regenerate follicles in animal models of premature ovarian failure (POF), differentiation into human oocytes has not been achieved.
This document discusses new concepts in oral contraceptive intake, specifically the 24/4 regimen. It begins by providing background on different generations of combined oral contraceptives. It then introduces the 24/4 regimen, which contains ethinylestradiol and drospirenone over 24 days followed by 4 hormone-free days. Studies show this regimen more effectively inhibits follicular development compared to the traditional 21/7 regimen. The 24/4 regimen provides 3 extra days of anti-mineralocorticoid and antiandrogenic effects, and may reduce hormone-withdrawal symptoms. A large observational study found the 24/4 regimen with drospirenone, specifically Yaz, had the lowest contraceptive failure rates including in
IVF errors can occur due to clinical, administrative, or embryo lab issues. While rare, mistakes are inevitable. Errors are graded based on their severity from none/minimal to major. Strict systems like double witnessing, barcodes, and electronic tracing can help avoid errors. If errors do occur, clinics should disclose this to patients to promote a culture of transparency and trust.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
9. Why Models!!
• Prediction models are intended to help
gynaecologists in patient communication and
decision making about treatment
10. How to Choose: Expectant
management or intervention
• Prediction models for Chance to concieve
naturally (home conception) (treatment
independent pregnancy)
• Prediction models for pregnancy after IVF
• Prediction models for pregnancy after IUI
16. Clinical consequences
• Couples with prognosis <30% = IVFCouples with prognosis <30% = IVF
• Couples with prognosis > 40% =Couples with prognosis > 40% =
expectant managementexpectant management
• Couples with prognosis 30-40% = IUICouples with prognosis 30-40% = IUI
17. Expectant management or
intervention
• Prediction models for Chance to concieve
naturally (home conception) (treatment
independent pregnancy)
• Prediction models for pregnancy after IVF
• Prediction models for pregnancy after IUI
18. Protocols for IVF
GnRH AntagonistGnRH Antagonist
ProtocolsProtocols
GnRHGnRH AgonistAgonist
ProtocolsProtocols
225 IU per day225 IU per day
(150 IU Europe)(150 IU Europe) Individualized Dosing of FSH/HMGIndividualized Dosing of FSH/HMG
250250 µµg per day antagonistg per day antagonist
Individualized Dosing of FSH/HMGIndividualized Dosing of FSH/HMG
GnRHa 1.0 mg per dayGnRHa 1.0 mg per day
up to 21 daysup to 21 days
0.5 mg per day of GnRHa0.5 mg per day of GnRHa
225 IU per day225 IU per day
(150 IU Europe)(150 IU Europe)
Day 6Day 6
of FSH/HMGof FSH/HMG
DayDay
ofof hCGhCG
Day 1Day 1
of FSH/HMGof FSH/HMG
Day 6Day 6
of FSH/HMGof FSH/HMG
DayDay
of hCGof hCG
7 – 8 days7 – 8 days
after estimated ovulationafter estimated ovulation
Down regulationDown regulation
Day 2 or 3Day 2 or 3
of mensesof menses
Day 1Day 1
FSH/HMGFSH/HMG
19. Which day!!!
• Day of start of cycle
• Day of start of stimulation
• Day of OPU
• Day of ET
• the time of embryo transfer will be more
accurate
• but limited since the couple has already gone
through the whole process of IVF.
20. Ideal model
• the probability of live birth in an IVF cycle
prior to start of ovarian stimulation.
21. Day of start: Baseline factors
• female age,
• duration of infertility,
• primary cause of infertility,
• duration of GnRH agonist use,
• Hormonal level
• the number of previous IVF cycle
22. • The age of the woman is still considered to be
the most important predictor of IVF success
(Broekmans and Klinkert, 2004).
23. • increasing duration of infertility has also been
shown to be negative impact , even after
adjustment for age, whereas previous
pregnancy increases the likelihood of success
(Collins et al., 1995; Templeton et al,1996).
24. • couples with different infertility diagnoses will
likely have different probabilities of achieving
a live birth
25. Ovarian reserve tests
• Basal FSH, inhibin B, and anti-Müllerian
hormone concentrations, as well as antral
follicles count can be used to measure the
ovarian reserve (Broekmans et al., 2006; Kwee
et al., 2008).
26. AMH
• If kits are available, AMH measurement could
be the most useful in the prediction of ovarian
response in anovulatory women.
• It is done at any day of cycle
• It is too expensive
• Exact normal levels not yet well agreed upon
27. ?Pregnancy
• correlation with the degree of response to
COH, but identifying poor responders by
means of these tests has low prognostic value
in relation to the chance of live birth after IVF
Broekmans et al. (2006)
28. How to build a model!
• Multivariate logistic regression analysis for
previous prognostic variables to create
prediction models of ovarian response and/or
ongoing pregnancy has been used to a lesser
extent (e.g., Bancsi et al., 2002).
29. Existing Models
• Most statistical models for prediction of IVF
outcome use both prestimulation parameters
and data obtained during the treatment, such
as data on embryos
32. Calculation
• The predicted probability (P) of achieving a live birth
after IVF was calculated using the Templeton the
model:
• Where y was defined as y = –2.028 + [0.00551x(age – 16)2] –
[0.00028x(age – 16)3] + [i – (0.0690x no. of unsuccessful IVF attempts)] –
(0.0711xtubal subfertility) + (0.7587xlive birth after IVF) + (0.2986 x
previous pregnancy after IVF which did not result in a live birth) +
(0.2277x live birth which was not a result of IVF) + (0.1117x previous
pregnancy, not after IVF and which did not result in a live birth).
35. • classified for each woman into one of three
groups, i.e.,
• (i) predictor of good prognosis
• (ii) intermediate prognosis
• (iii) predictor of poor prognosis.
36. Expectant management or
intervention
• Prediction models for Chance to concieve
naturally (home conception) (treatment
independent pregnancy)
• Prediction models for pregnancy after IUI
• Prediction models for pregnancy after IVF
37. Prognostic factors of pregnancy in
intrauterine insemination
• Women with intermediate prognosis
43. Take Home Message
• Prediction models are now available and
ready for use
• Female age is the overwhelming factor
affecting prediction models
• The prognosis should be discussed clearly with
the patients based on scientific evidence and
existing models.