This document discusses factors that influence embryo implantation, including the quality of the embryo (seed) and endometrium (soil). It describes techniques for evaluating egg/sperm quality like oocyte scoring and assessing sperm structural defects and DNA damage. Methods of improving egg, sperm, and embryo quality are provided. The document also discusses endometrial receptivity, factors that influence it, and techniques like endometrial biopsy and receptivity array testing to assess the endometrium. Ways to improve endometrial lining through treatment of issues like thin endometrium are covered. Other external factors beyond the seed and soil that can also influence implantation are briefly mentioned. The conclusion emphasizes the importance of selecting the best embryo and
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Free Information Session 5th September 2012: Recent Breakthroughs in IVFFertility SA
Dr Louise Hull spoke about new technologies which are improving outcomes and making fertility treatment a more straightforward process. She covered how they fit into our current treatment plans, the reasons for developing them and the evidence regarding the benefits.
Dr Hull has worked in fertility services since she graduated as a doctor 15 years ago. She became Obstetrician and Gynaecologist (FRANZCOG) after gaining clinical experience in New Zealand and Cambridge and Somerset in the UK. Louise has a strong interest in reproductive medicine and has worked in IVF units in New Zealand, England and Australia, including Bourn Hall, the fertility centre where the first IVF baby was born. For more information about Dr Hull, please follow this link: http://www.fertilitysa.com.au/dr-m.-louise-hull-specialist.html
Mark Perloe, MD Atlanta, 404-843-2229 Learn about the factors that can adversely affect fertility and the tests that can help pinpoint problems. Fertility treatment options including IVF and other high tech options are presented.
IVF and getting pregnant are very complex procedures and the combination of both sometimes seems to be an impossible task.
So there are many additional treatments used to improve implantation and pregnancy rates. Which are really helpful and which just helps the doctor earn somme money?
Here you find a short overview, bus certainly not all the answers to the questions above.
Higher Number of Embryos
Blastocyst culture
PID
IMSI
Hatching
Acupuncture
ASS
Heparin
Prenatal Testing, deteksi kelainan bawaan sejak dalam kandunganHendrik Sutopo
Pengenalan mengenai prenatal diagnosis.
Memberikan gambaran sekilas mengenai cara-cara untuk mengetahui kelainan bawaan sejak janin dalam kandungan.
lebih ditujukan untuk kalangan medis.
Non Invasive Prenatal Testing (NIPT)
Invited Lecture delivered by Dr Sujoy Dasgupta in National Youth Conference, held at Patna in August 2019. This session was sponsored by Bharat Serum and Vaccines
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Free Information Session 5th September 2012: Recent Breakthroughs in IVFFertility SA
Dr Louise Hull spoke about new technologies which are improving outcomes and making fertility treatment a more straightforward process. She covered how they fit into our current treatment plans, the reasons for developing them and the evidence regarding the benefits.
Dr Hull has worked in fertility services since she graduated as a doctor 15 years ago. She became Obstetrician and Gynaecologist (FRANZCOG) after gaining clinical experience in New Zealand and Cambridge and Somerset in the UK. Louise has a strong interest in reproductive medicine and has worked in IVF units in New Zealand, England and Australia, including Bourn Hall, the fertility centre where the first IVF baby was born. For more information about Dr Hull, please follow this link: http://www.fertilitysa.com.au/dr-m.-louise-hull-specialist.html
Mark Perloe, MD Atlanta, 404-843-2229 Learn about the factors that can adversely affect fertility and the tests that can help pinpoint problems. Fertility treatment options including IVF and other high tech options are presented.
IVF and getting pregnant are very complex procedures and the combination of both sometimes seems to be an impossible task.
So there are many additional treatments used to improve implantation and pregnancy rates. Which are really helpful and which just helps the doctor earn somme money?
Here you find a short overview, bus certainly not all the answers to the questions above.
Higher Number of Embryos
Blastocyst culture
PID
IMSI
Hatching
Acupuncture
ASS
Heparin
Prenatal Testing, deteksi kelainan bawaan sejak dalam kandunganHendrik Sutopo
Pengenalan mengenai prenatal diagnosis.
Memberikan gambaran sekilas mengenai cara-cara untuk mengetahui kelainan bawaan sejak janin dalam kandungan.
lebih ditujukan untuk kalangan medis.
Non Invasive Prenatal Testing (NIPT)
Invited Lecture delivered by Dr Sujoy Dasgupta in National Youth Conference, held at Patna in August 2019. This session was sponsored by Bharat Serum and Vaccines
In-vitro fertilization (IVF) is a process by which oocytes are fertilized by sperm outside the women’s womb, in vitro. It still represents one of the most exciting modern scientific developments and continues to have a tremendous impact on
people's lives.
Here, we will discuss all about the embryo development inside the dish.
Also we discuss which embryo to choose for transferring into female's uterus.
This presentation covers the topic such as Male & Female Infertility Overview, approach & evaluation. Infertility is a condition in couples, failed to get a successful pregnancy after twelve months of timed unprotected intercourse or therapeutic donor insemination.
Eden fertility center serves as a unique fertility clinic with advanced facilities and state-of-the-art equipment to ensure excellent patient care. We deliver possibly the most advanced fertility treatments in Newport Beach & Fullerton CA
Eden Centers for Advanced Fertility offers patients the most advanced treatment solutions & also gives excellent quality patient care. We are a group of highly trained specialists who've innovative concepts for fertility treatment depending on three main principles: individualized personal care, excellent medical service & effective benefits.
Services We Offer -
Fertility Treatments
Third-Party Reproduction
Genetic Testing
Male Infertility
Egg Freezing - Oocyte Preservation
Fertility Preservation
Investigations for iufd & sb, how to select?Wafaa Benjamin
Foetal loss is a distressing situation for the lady ,family and medical staff as well.
Investigating the cause of death has many benefits .
Meticulous history taking and clinical assessment is of at most importance.
There are routine standard tests & others arte selective directed by clinical scenarios.
Researches & recording are required to estimate main causes of foetal death at local level, so, investigations could be directed.
In presence of lack of resources, selection of investigations should be prioritized by most relevant and most informative ones.
Post-mortem examination should be re-included at least external examination & placental histopathology.
The placenta is formed gradually during the first three months of pregnancy, while, after the fourth month, it grows parallel to the development of the uterus. Once completed, it resembles a spongy disc 20 cm in diameter and 3 cm thick.
Similar to Seed, Soil and Beyond in Infertility Treatment (20)
Strategies for improving success in Poor respondersKaberi Banerjee
Overcoming challenges associated with poor ovarian response is a critical aspect of in vitro fertilization (IVF) for individuals classified as poor responders. Various strategies can be employed to enhance the chances of success in this particular group of patients.
Firstly, individualized ovarian stimulation protocols play a crucial role. Tailoring medication dosages and adjusting the type of gonadotropins used based on the patient's age, ovarian reserve, and response to previous stimulation cycles is essential. Utilizing personalized approaches can optimize follicular development and improve egg yield.
Co-administration of adjuvant medications is another effective strategy. Growth hormone supplementation has shown promise in enhancing ovarian response and improving the quality of eggs in poor responders. Additionally, androgen pre-treatment has been explored as a means to improve ovarian function and response to stimulation.
Advancements in laboratory techniques, such as the use of time-lapse imaging systems, can aid in the selection of the most viable embryos for transfer. This ensures that the highest-quality embryos are chosen, increasing the chances of successful implantation.
Embryo transfer techniques also play a significant role in optimizing success for poor responders. Employing the assisted hatching technique or using preimplantation genetic testing (PGT) to screen embryos for chromosomal abnormalities can improve implantation rates.
In some cases, considering alternative approaches such as natural cycle IVF or minimal stimulation IVF may be beneficial for poor responders. These protocols aim to work with the patient's natural cycle or use lower doses of medications to reduce the risk of overstimulation and improve egg quality.
Furthermore, addressing lifestyle factors that may impact fertility, such as nutrition, stress management, and adequate sleep, is crucial for optimizing outcomes in poor responders.
In conclusion, a multifaceted approach is essential for improving success in poor responders undergoing IVF. By customizing ovarian stimulation protocols, incorporating adjuvant medications, leveraging advanced laboratory techniques, optimizing embryo transfer, and considering alternative protocols, fertility specialists can enhance the chances of a positive outcome for individuals facing the challenge of poor ovarian response.
Embryo Transfer- Tips and Tricks to improve successKaberi Banerjee
Improving embryo transfer technique is crucial in the field of assisted reproductive technology (ART) as it significantly influences the success of in vitro fertilization (IVF) procedures. A well-executed embryo transfer is vital for the optimal implantation of embryos, leading to a higher likelihood of a successful pregnancy. Here are several key strategies to enhance the embryo transfer technique:
Firstly, proper training and skill development for the fertility specialist or clinician performing the procedure are essential. Training programs that emphasize hands-on experience and guidance from experienced practitioners contribute to proficiency in embryo transfer. Continuous professional development ensures that practitioners stay updated on the latest advancements in the field.
Secondly, utilizing ultrasound guidance during embryo transfer enhances precision. Real-time visualization enables the clinician to accurately navigate the catheter through the cervix and deposit the embryos in the ideal location within the uterine cavity. This minimizes the risk of trauma and increases the chances of successful implantation.
Maintaining a relaxed and comfortable environment during the procedure is equally important. Studies suggest that minimizing stress and anxiety in both the patient and the clinician can positively impact the success of embryo transfer. This involves effective communication with the patient, addressing any concerns, and ensuring a supportive atmosphere in the clinic.
Optimizing the timing of embryo transfer concerning the woman's menstrual cycle is another critical factor. Synchronization between the embryo's developmental stage and the endometrial receptivity is vital. Personalized protocols and careful monitoring of hormonal levels contribute to better timing, enhancing the chances of successful implantation.
Lastly, considering individualized patient factors, such as uterine anatomy and the woman's overall health, is essential. Tailoring the embryo transfer technique to the specific needs of each patient increases the likelihood of a positive outcome.
In conclusion, continuous education, technological advancements, personalized approaches, and a patient-centered focus are key elements in improving the embryo transfer technique. Implementing these strategies can contribute to higher success rates in IVF procedures, bringing hope to individuals and couples seeking to build their families through assisted reproductive technologies.
The thin endometrium refers to the lining of the uterus, known as the endometrium, being insufficiently thick. This condition is typically characterized by a reduced thickness of the endometrial layer, which plays a crucial role in supporting the implantation and development of a fertilized egg during the menstrual cycle.
A thin endometrium is commonly associated with hormonal imbalances, such as low estrogen levels, which are vital for the growth and maintenance of the endometrial tissue. Inadequate blood flow to the uterus, chronic inflammation, or certain medical conditions can also contribute to this condition. Women with a thin endometrium may experience difficulties in achieving and maintaining pregnancy, as the thin lining may not provide an optimal environment for the embryo to implant and thrive.
Addressing the underlying causes of a thin endometrium often involves hormonal therapies to regulate estrogen levels, lifestyle modifications, and sometimes surgical interventions. Fertility treatments, such as in vitro fertilization (IVF), may be considered to overcome the challenges associated with a thin endometrium.
In conclusion, a thin endometrium can pose challenges to fertility and reproductive health, requiring a comprehensive approach to address the underlying factors and improve the chances of successful conception.
Preimplantation Genetic Testing - Dr Kaberi BanerjeeKaberi Banerjee
Preimplantation Genetic Testing for Aneuploidy (PGT-A), formerly known as preimplantation genetic screening (PGS), is a technique used during in vitro fertilization (IVF) to screen embryos for chromosomal abnormalities before implantation. Like any medical procedure, PGT-A has both advantages and disadvantages.
Pros of PGT-A:
Reduced Risk of Aneuploidy: PGT-A helps identify embryos with chromosomal abnormalities, such as aneuploidy, which can reduce the risk of implantation failure, miscarriage, and certain genetic disorders.
Improved IVF Success Rates: By selecting embryos with the correct number of chromosomes, PGT-A can enhance the chances of a successful implantation and a healthy pregnancy, leading to improved overall IVF success rates.
Reduced Miscarriage Rates: Identifying and transferring embryos with the correct chromosomal makeup may decrease the likelihood of spontaneous miscarriages, particularly in older women who are at a higher risk of producing embryos with chromosomal abnormalities.
Family Planning for Genetic Disorders: PGT-A allows couples at risk of transmitting specific genetic disorders to screen embryos for these conditions, enabling them to make informed decisions about which embryos to implant.
Cons of PGT-A:
No Guarantee of Pregnancy: PGT-A does not guarantee a successful pregnancy. Other factors, such as uterine receptivity, can still impact the success of embryo implantation.
False Positives and Negatives: PGT-A is not foolproof, and false positives and negatives can occur. In some cases, embryos identified as abnormal may be viable, leading to the potential discarding of healthy embryos, or vice versa.
Invasive Nature: The procedure involves removing a small number of cells from the developing embryo, which some argue could potentially harm the embryo, although the impact is generally considered minimal.
Financial Cost: PGT-A adds an additional cost to the already expensive IVF process. The financial burden may be a significant consideration for some couples, especially if insurance does not cover the expense.
Limited Scope: PGT-A primarily screens for numerical chromosomal abnormalities and may not detect all genetic disorders or structural chromosomal abnormalities. Additional testing, such as preimplantation genetic testing for monogenic disorders (PGT-M) or preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR), may be necessary for a more comprehensive assessment.
In summary, while PGT-A offers potential benefits in terms of reducing the risk of aneuploidy and improving IVF success rates, it is essential for couples to weigh these advantages against the potential drawbacks and consider their individual circumstances, including the financial and emotional aspects of the procedure.
Endometrial Receptivity Array- Dr Kaberi BanerjeeKaberi Banerjee
The endometrial receptivity array (ERA) is a diagnostic tool used in assisted reproductive technology (ART) to assess the receptivity of the endometrium, or the lining of the uterus, during the implantation window. While ERA has shown promise in improving the chances of successful embryo implantation, it also comes with its own set of advantages and disadvantages.
Pros of Endometrial Receptivity Array (ERA):
Personalized Timing: ERA helps determine the optimal window of endometrial receptivity for a specific woman. This personalized approach aims to synchronize the embryo transfer with the most favorable conditions for implantation, potentially improving the chances of successful pregnancy.
Reduced Pregnancy Loss: By accurately identifying the receptive window, ERA may contribute to reducing the risk of implantation failure and early pregnancy loss, especially in cases where previous IVF cycles were unsuccessful.
Improved Treatment Precision: ERA provides a more precise understanding of the individual's endometrial cycle, allowing fertility specialists to tailor the timing of embryo transfer to maximize the likelihood of success. This personalized approach may be particularly beneficial for women with irregular menstrual cycles.
Enhanced Cost-Efficiency: While the initial cost of an ERA test is an additional expense in the IVF process, the potential for increased success rates and reduced need for repeated embryo transfers may lead to cost savings in the long run.
Cons of Endometrial Receptivity Array (ERA):
Limited Evidence: Some critics argue that there is limited conclusive evidence supporting the routine use of ERA in all IVF cycles. The effectiveness of ERA is still a topic of ongoing research, and its widespread adoption may require more comprehensive validation.
Additional Cost: The ERA test adds an extra cost to the already expensive IVF process. Some couples may find it financially burdensome, especially if insurance coverage does not include this diagnostic procedure.
Invasive Nature: The endometrial biopsy required for the ERA test is an invasive procedure that may cause discomfort and pose a slight risk of infection or bleeding. However, the risks are generally minimal.
Time Consumption: The time required for the ERA test may extend the overall duration of the IVF process, which can be a concern for couples seeking a more expedited fertility treatment.
In conclusion, while the endometrial receptivity array offers potential benefits in improving IVF success rates through personalized timing, its adoption should be carefully considered based on individual circumstances, including financial considerations and the need for further research on its long-term efficacy.
Single embryo transfer (SET) is a reproductive technique employed during in vitro fertilization (IVF) that involves transferring only one embryo into the uterus. This approach has both advantages and disadvantages, influencing the decision-making process for couples and fertility specialists.
Pros of Single Embryo Transfer (SET):
Reduced Multiple Births: One of the primary benefits of SET is the significant reduction in the occurrence of multiple pregnancies, such as twins or triplets. Multiple pregnancies are associated with higher risks for both the mother and the babies, including preterm birth and low birth weight.
Enhanced Pregnancy Success Rates: Focusing on transferring a single embryo allows for better control and optimization of the conditions for implantation. This can result in higher success rates per transfer, increasing the likelihood of a healthy pregnancy.
Lower Risk of Complications: Single embryo transfers minimize the risk of complications associated with multiple pregnancies, such as gestational diabetes, preeclampsia, and cesarean section. This can lead to better maternal and neonatal outcomes.
Cost Savings: Although the initial cost of IVF is not necessarily reduced with SET, the long-term costs associated with caring for multiple preterm infants and potential complications are significantly lower.
Cons of Single Embryo Transfer (SET):
Lower Pregnancy Rates per Cycle: While SET can result in higher success rates per transfer, the overall pregnancy rates per IVF cycle may be lower compared to transferring multiple embryos. This can be a concern for couples with limited resources or time.
Potential Need for Multiple IVF Cycles: Achieving pregnancy with SET may require multiple IVF cycles, extending the time and financial investment for couples trying to conceive.
Emotional Stress: The uncertainty of success with each cycle can contribute to emotional stress for couples undergoing fertility treatments, particularly if they experience multiple unsuccessful attempts.
Age-Related Factors: For older women with diminished ovarian reserve, transferring a single embryo may further reduce the chances of success. In such cases, the decision to transfer multiple embryos may be considered based on individual circumstances.
In conclusion, the choice between single and multiple embryo transfer in IVF involves weighing the potential benefits of a healthy, singleton pregnancy against the desire for higher success rates and faster conception, considering the unique circumstances of each couple.
Chronic endometritis and its effect on FertilityKaberi Banerjee
Chronic endometritis, inflammation of the endometrial lining, may hinder fertility by disrupting the implantation process. Early diagnosis and treatment are crucial for optimizing reproductive outcomes and addressing infertility challenges.
"Embryo Transfer Strategies: Cleavage vs. Blastocyst"
Brief overview of the significance of embryo transfer in assisted reproductive technologies (ART) and the focus on cleavage and blastocyst stages with their merits and demerits.
"Transforming Reproductive Medicine with AI"
Brief overview of the impact of AI on various fields, leading into its applications in reproductive medicine.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
4. Oocyte Scoring
Cumulus-oocyte complex scoring
Binary score (0 or 1)
‘Good’ COC (score of 1) - expanded cumulus and a
radiating corona
Zona pellucida scoring
Colour or thickness of the zona pellucida.
Perivitelline space - Presence of inclusions
Polar body scoring
Presence or absence of the first polar body
Size of the polar body (Abnormally large polar body - risk
of oocyte aneuploidy
Cytoplasm scoring – Check for ‘granularity’ of
cytoplasm
Vacuolization - Large vacuoles (>14 microm in
diameter) - fertilization failure.
6. Sperm structural defects
Defect can occur in
Head (vacuoles)
Acrosome (agenesis - “globozoospermia” )
Midpiece
Tail
Evaluate by transmission electron microscopy
(TEM)
Inform fertilizing competence of sperm
Identify potentially inheritable genetic
disorders (primary ciliary dyskinesia,
Kartagener’s syndrome)
7. Sperm DNA damage
Sperm DNA
Fragmentation - breaks
in DNA double strand
due to agressions
8. Sperm DNA fragmentation
Occur in
Infection or inflammatory of genital tractus
Varicocele
Testicular maldescent
Impaired spermatogenesis
Radiotherapy or chemotherapy
Exposition to heat, chemical products
Idiopathic
9. Sperm DNA fragmentation
Tests
TUNEL
Comet
CMA3
in-situ nick translation
DBD-FISH (DNA breakage detection fluorescence in situ
hybridization)
Sperm chromatin dispersion test (SCD)
SCSA
13. Cleavage-stage embryos
Assessment of cell number
Fragmentation
Extracellular membrane-bound cytoplasmic
structure that is <45 microm diameter in a Day-2
embryo and <40 microm diameter in a Day-3 embryo
Mild (<10%); moderate (10–25%) and severe (>25%)
Multinucleation
Cell size
Other morphological features of Day-2 and -3
embryos
Cytoplasmic granularity, membrane appearance and
presence of vacuoles
17. Non-viable embryo
Embryo in which development has been
arrested for at least 24 h
or
Embryo in which all the cells have
degenerated or lysed
18. Embryoscope - Time-lapse
analysis
Novel non-invasive method
Dynamic morphometric assessment
Monitor embryo development continuously
Allows precise measurement of 1st
cleavage time, PN fading
Prevents from taking the dishes out of the
incubator
25. Improving Seed (Embryo)
Preimplantation genetic
screening
Blastocyst transfer
Assisted hatching
Zygote intra-Fallopian
transfer
Co-culture
26. Pre-implantation genetic
diagnosis (PGD)
Genetic analysis of a
single cell from an
embryo done in
conjunction with in vitro
fertilization (IVF)
Genetic counseling
before procedure
27. PGS indications
Recurrent miscarriages
One child already affected with a genetic disease
Family history of inherited disease
Maternal age older than 38
Prior failure with IVF
28. PGD Method
Ovulation Induction with drugs
Egg Retrieval
Fertilization
Biopsy
Unfertilised and fertilised oocytes (for polar
bodies, PBs)
On day three cleavage-stage embryos (for
blastomeres – Preferable)
On blastocysts (for trophectoderm cells)
Genetic Analysis (FISH, PCR)
Embryo Transfer
29.
30. PGD Risk
• Low birth weight; premature birth
• Developmental delays
• Cognitive problems (ADHD)
• Urogenital problems
• Cerebral palsy
• Certain cancers (e.g., Beckwith-Weidemann syndrome,
which may be related to ICSI)
46. Endometrial Receptivity Array
(ERA) Genetic test to diagnose state of
endometrial receptivity in window of
implantation
Analyse expression levels of 238 genes
related to status of endometrial
receptivity
Recommended for younger women with at
least 3 failed embryo transfers or for
patients 37 years or more with 2 failed
embryo transfers
47. Endometrial Receptivity Array
Endometrial biopsy –
Natural cycle at day 21 i.e 7 days after LH surge
LH+7 or 6 days after the follicle rupture, when
monitored by ultrasound)
Hormone replacement therapy cycle after 5 full
days of progesterone impregnation in HRT cycles
After biopsy - immediately introduced into an
“ERA cryotube” containing fluid that allows
preservation of tissue
48. ERA – Interpretation
Receptive (R):
Gene expression profile corresponds to a normal receptive
endometrium.
Recomended to proceed with embryo transfer at the
indicated WOI
Non Receptive (NR):
Gene expression profile does not correspond to normal
receptive endometrium.
Not recomended to proceed with embryo transfer at the
indicated WOI and a personalization of the WOI is advised
49.
50. Improving Soil
Hysteroscopic correction of cavity
pathology
Myomectomy
Treatment of thin endometrium (High-
dose estrogens, low-dose aspirin &
vaginal sildenafil,arginine)
Endometrial stimulation (biopsy) -
pseudo-decidual reaction
Immunotherapy (intravenous
immunoglobulin, steroids, aspirin and
heparin)
Changing day of transfer
54. Hydrosalpinx
Fluid causes
Mechanical effects
Embryo and gametotoxicity
Alterations in endometrial receptivity
markers, resulting in poor implantation
Direct effect on the endometrium, leading
to intrauterine fluid formation
55.
56. Multifactorial treatment
options
Treating endometriosis – Laparoscopic approach
Salpingectomy in case of hydrosalpinges
Tailoring the stimulation protocols – Use of GnRH-
antagonist protocol
Psychological assistance
Embryo transfer techniques
Adjunctive treatment (Metformin, Bromocriptine,
Thyroxine)
Alternative treatment