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.
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
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.
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
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.
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
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
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
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
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
The Impact of Chinese Herbal Medicine on In Vitro Fertilization Outcomes A Sy...keith644288
Many are familiar with acupuncture and its possible benefits for infertility patients. Numerous studies on IVF and acupuncture have been conducted over the last twenty-five years. In the United States fewer are aware that historically in China the specialty of women’s health in Chinese medicine is almost exclusively herbal. In Vitro Fertilization has now been in use for 40 years, originally developed to help women conceive who had blocked fallopian tubes. Recent advances in freezing embryos and preimplantation genetic testing for aneuploidies (PGT-a) have helped physicians gradually increase their IVF rates of success. Pregnancy rates at some of the nation’s top fertility clinics hover at approximately 65%. Physicians and patients alike continue to seek novel methods to further optimize their IVF cycles. This work seeks to explore mechanisms of action and the impact of one of the world’s most ancient medical systems, Chinese medicine’s Chinese herbal medicine (CHM) on the outcomes of IVF.
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
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.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Live birth by fallopian tube sperm perfusion in hyperprolactinemic woman afte...lukeman Joseph Ade shittu
The case presented describes a live birth following treatment of a 35-year-old woman with fallopian tube sperm perfusion (FTSP) using donor sperm after three-repeated unsuccessful courses of In-vitro fertilization (IVF) with Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Extraction (TESE), and donor sperm. The indication of FTSP is hereby explored and discussed.
Why we need to predict?
Hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis
Psychological Depression
Low levels of self esteem and Life satisfaction
Sexual Dysfunction
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
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
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
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
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
The Impact of Chinese Herbal Medicine on In Vitro Fertilization Outcomes A Sy...keith644288
Many are familiar with acupuncture and its possible benefits for infertility patients. Numerous studies on IVF and acupuncture have been conducted over the last twenty-five years. In the United States fewer are aware that historically in China the specialty of women’s health in Chinese medicine is almost exclusively herbal. In Vitro Fertilization has now been in use for 40 years, originally developed to help women conceive who had blocked fallopian tubes. Recent advances in freezing embryos and preimplantation genetic testing for aneuploidies (PGT-a) have helped physicians gradually increase their IVF rates of success. Pregnancy rates at some of the nation’s top fertility clinics hover at approximately 65%. Physicians and patients alike continue to seek novel methods to further optimize their IVF cycles. This work seeks to explore mechanisms of action and the impact of one of the world’s most ancient medical systems, Chinese medicine’s Chinese herbal medicine (CHM) on the outcomes of IVF.
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
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.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Live birth by fallopian tube sperm perfusion in hyperprolactinemic woman afte...lukeman Joseph Ade shittu
The case presented describes a live birth following treatment of a 35-year-old woman with fallopian tube sperm perfusion (FTSP) using donor sperm after three-repeated unsuccessful courses of In-vitro fertilization (IVF) with Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Extraction (TESE), and donor sperm. The indication of FTSP is hereby explored and discussed.
Why we need to predict?
Hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis
Psychological Depression
Low levels of self esteem and Life satisfaction
Sexual Dysfunction
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
This is a lecture from a series of an acupuncture training course held in Mysuru, India.
<About the Course>
'Arouse the life zeal within you' through acupuncture, to heal head to toe without drugs. This training will focus on the TCM theories, its applications, diagnosis & cupping techniques. As the premier event, we have unique opportunity of having the experts of acupuncture from Taiwan as resource trainers.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. TCM on Patients undergoing IVF
Current evidences and clinical practice
Center for Traditional medicine, Taipei Veterans General Hospital
Chu-Feng Wu M.D.
2021.12.08
2. TCM Utilization rates are unclear
• 428 Northern Californian couples, 22% reported using acupuncture
(Smith et al., 2010)
• 118 Boston-area women surveyed, 47% women reported using
acupuncture and 17% used herbs during their assisted reproduction
technique cycle (Domar et al., 2012)
• 77 patients found that 92% reported using acupuncture to support
their IVF cycle (Aelion et al., 2009)
3. More than we think
• Self-referral
• IVF physician may refer
• IVF physicians may not be aware of patient use of these additional
therapies (Boivin and Schmidt, 2009)
5. Inclusion criteria
• Of 1509 patient charts, only NCRS patients who underwent IVF
with fresh donor or non-donor embryos transferred between
August 2005 and December 2010 were included, regardless of
embryo quality.
• Women who underwent pre-implantation genetic screening testing
or intracytoplasmic sperm injection cycles were also included.
• To further reduce selection bias, all biomedical diagnoses were
included.
6. Exclusion criteria
• All patients who underwent transfers with frozen embryos (n = 251)
or embryos from frozen oocytes (n = 27, research cycles) were
excluded.
The Oregon College of Oriental Medicine Institutional
Review Board approved this study on 11 January 2011
(IRB reference number 09–028).
7.
8.
9. Whole-systems traditional Chinese medicine
(WS-TCM)
• At the initial visit, the patient’s biomedical chart was reviewed.
The patient was assessed according to TCM theory.
• Patient visits were typically once a week and increased in
frequency to twice a week from the start of IVF suppression
medications to oocyte retrieval.
• One more visit was suggested 5–7 days after embryo transfer to
reduce stress.
• 精卵的成熟、成熟卵泡的排出、黃體支持、妊娠維持
10. Treatment is individualized 辨證論治
• Acupuncture and herbal treatment was based on TCM pattern
diagnosis and phase of menstrual cycle.
• A detailed WS-TCM treatment plan was provided outlining the dose
and frequency of acupuncture, electro-acupuncture, Chinese
medicine-based dietary suggestions, lifestyle recommendations,
and any recommended nutritional supplements.
• A course of treatment can range from six to 24 treatments
depending on the complexity of the case.
• All customized Chinese herb formulas were dispensed in granular
form and manufactured by KPC herbs (Taiwan).
11.
12. 調周法
• Regulating the menstrual cycle is considered a central treatment
approach to female reproduction (Cochrane et al., 2014)
• Treatment was divided into four phases:
• menses [cycle days 1–4],
• follicular [cycle days 5–11],
• ovulation [cycle days 12–16],
• and luteal [cycle days 17 to onset of menses]
14. 排卵前
• During menses, treatment was directed at regulating menses and
reducing of dysmenorrhea pain, if present(Smith et al., 2011).
• Follicular phase treatment was directed at regulating reproductive
hormones (Chen, 1997; Napadow et al., 2008), and endometrial
(Stener-Victorin et al., 1996) and follicular development (Rashidi
et al., 2013).注重陰分。歸芍地黃湯, 養精種玉丹, 補天種玉丹
15. 排卵後
• Ovulation phase treatment was directed at inducing
ovulation(Jedel et al., 2011; Johansson and Stener-Victorin, 2013;
Johansson et al., 2013; Stener-Victorin et al., 2012).氤氳之候,活
血通絡。補腎促排卵湯, 健脾促排卵湯
• Luteal phase treatment focused on regulating hormones (Cochrane
et al., 2014).黃體功能不全是腎陽虛不孕症常見類型,溫腎助陽。毓
麟珠-溫腎健脾法
16. During the IVF cycle
• During down-regulation and ovarian stimulation, treatment was
aimed to improve ovarian and uterine blood flow (Magarelli et al.,
2009; Stener-Victorin et al., 1996), improve oocyte quality
(Rashidi et al., 2013) and reduce stress.
• Acupuncture was optional on the day of oocyte retrieval to
manage pain (Gejervall et al., 2005; Humaidan et al., 2006;
Stener-Victorin, 2005), or postoperative nausea, vomiting, or both
(Cheong et al., 2013a)
17. Acupuncture on the day of
embryo transfer (ACU)
• The first acupuncture session took place 1 h and 15 min before
embryo transfer, and the second no more than 30 min after the
embryo transfer.
• Before embryo transfer: GV-20/Baihui; PC-6/Neiguan; CV-6/Qihai;
ST-29/Guilai; SP-8/Diji; LR-3/Taichong; right ear (uterus,
endocrine); left ear (Shenmen, Brain).
• After embryo transfer: LI-4/Hegu; SP-10/Xuehai; ST-36/Zusanli;
SP-6/Sanyinjiao; KI-3/Taixi; right ear (Shenmen, Brain); and left
ear (uterus, endocrine).
18. • In this retrospective
study, adjuvant WS-TCM
and IVF was associated
with increased odds of
live birth in women aged
38 to 42 years old.
Outcomes
Live births in women who integrate whole
systems traditional Chinese medicine with
IVF does age matter?
20. Patients
• Extracted data from charts from their community clinics of shared
fertility clinic patients who added acupuncture therapy prior to
embryo transfer (ET).
• Cycles with gestational carriers, donor eggs, no transfer, or
embryos without chromosomal screening were excluded.
21. Interventions and Comparison
• UC group: usual care for women who completed FET alone
• ET Acu group: UC and ET Acu of two standardized acupuncture
sessions before and after ET
• TCM group: UC, ET Acu and acupuncture therapy received in the
community prior to ET that included Traditional Chinese Medicine
therapies such as diet and lifestyle modifications, warming
therapy, or if appropriate, Chinese herbal therapy.
22. Outcomes
• There was no difference in live births between UC (67.7%) and TCM (64.6%,
p=0.35), but both groups were associated with significantly more live births
over ET Acu (55.3%, p=0.005 and 0.05, respectively).
• The rate of miscarriage was also similar between UC (6.6%) and TCM (8.9%,
p=0.20), but again, both were associated with significantly less than ET Acu
(15.3%, p=0.001 and 0.03, respectively).
• Patients who chose ET Acu and TCM differed on important variables that
may predict birth outcomes thereby limiting interpretation.
23.
24. Repeated implantation failure (RIF)
• Main reasons as follows:
• limited potential development of embryos (e.g., abnormal chromosomes
and blood types, abnormal male sperm quality);
• impaired endometrial receptivity;
• compatibility between the embryo and endometrium
• However, even when there are high quality embryos, some
maternal factors such as age, pelvic environment, intrauterine
factors, endometrial receptivity, and hydrosalpinx and
psychological factors will still lead to the occurrence of RIF.
• Consider TCM for Endometrial Preparation
25. Inclusion Criteria
• RIF with three or more implantation failures in previous IVF/ICSI
cycles.
• High-quality embryos were subjected to cryopreservation by
vitrification, and were still in good condition after being thawed.
• CM standard was in accordance with deficiencies in Spleen and
Kidney functions.
26.
27. Endometrial Mechanical Stimulation
• Hysteroscopic examinations to exclude organic endometrial
problems
• Intrauterine device (IUD) was removed after 2 months and then
the endometrium was stimulated softly again.
• Hysteroscopy was performed using a digital camera (Tricam SLII,
Germany, Carl Stortz, Tuttlingen, Germany).
28. The sequential therapy of (Yupei Qisun) in CM
• The first stage started 60 days before FET. Bushen Jianpi Recipe
(補腎健脾方) was given to invigorate the Spleen and Kidney.
• The second stage started about 19 to 30 days before FET according
to the various methods of endometrial preparation. Bushen Jianpi
Recipe and the modified Erzhi Pill (加味二至丸) were given.
• The third stage started from 14 to 60 days after FET depending on
the pregnancy result. Bushen Jianpi Recipe and Shoutai Pill (壽胎
丸) were given.安胎並舉
• All herbs were boiled by the Pharmacy of Shuguang Hospital.
29. • Sixty-six infertile patients with Kidney-yin deficiency syndrome undergo in
vitro fertilization-embryo transfer (IVF-ET).
• The dosage and duration of Gn were significantly lower in the treatment
group than that in the control group (P<0.05).
• The high quality oocyte and embryo rates, and clinical pregnancy rate were
all higher in the treatment group than those in the control group (P<0.05).
30. Outcomes
• The mean endometrial thickness in the CM group was greater than in the
hysteroscopy group, but the difference was not statistically significant.
• The increased level of DNMT1 protein expression after treatment may
lead to the enhanced endometrial receptivity.
• No statistically significant difference in the abnormal pregnancy rate
among the groups.
31.
32. Clinical Cases in VGH
• 32 y/o, MARRIED FOR 4 YEARS, G0P0, WANT A BABY(AIHX3 W/ CLOMID -GONA-F-
HCG OR PROFASI FAIL AT NTUH)
• D/I: 5-7/24-26, moderate amount, blood clot(-), low back soreness,
menorrhagia associated with headache and nausea, LMP:2007-9/24, Hx of
POLYPECTOMY+ D&C ON 2001, TVS: EM: 9.1 mm, LEFT CHOCOLATE CYST;MYOMA
2CM; LAPAROSCOPY: BIL. TUBES OCCLUSION, R/O ENDOMETRIOSIS OF OVARY
• SEMEN=93M;M=56% NF 55%;HSG;+/+,SUGGEST IVF BY DR. YANG
• FSH: 10.30
• E2: 28.95
• PRL: 11.87
• AMH:>1.0
• Impression: IDIOPATHIC INFERTILITY R/O ENDOMETRIOSIS 血瘀證receptivity?
33. 中西醫整合治療 SINCE 2007-5/24
• Rx. Utrogestan 100 mg TID, Leuprolide acet.*inj5mg/ml 2.8ml
• FET x3 preceding with Leuplin 6M discomfort(++)
• Low abdominal fullness and low back soreness, some vaginal spotting, acne,
constipation, dry mouth, shallow sleep with lots of dreams, high stress due
to family factors…
• TCM 補腎調周法(測量基礎體溫)+逐瘀+療程症狀治療
• 若需停服中藥期間可單用Acupuncture (see another case)
• 2008-08 EMBRO TRANSFER x2, 2008-9/1 HCG+, LIVE BIRTH x1
(EDC on 2009-05)
TCM IVF cycle:預處理階段、啟動階段、板機日間、取卵後進入健黃體治療時期
34. Take Home Messages
• The retrospective studies suggest that TCM as an adjuvant IVF
treatment may improve live birth rates in patients undergoing
fresh or frozen embryo transfer.
• 中醫在心腎陰陽,肝脾氣血,衝任督帶及子宮的總體調控下,達成女
性生理功能規律變化,減少IVF療程中的不適感。
籌辦中