Counseling plays an important role in assisted reproductive technology (ART) by helping patients cope with stress and make difficult decisions. There are three main types of counseling: implication counseling to discuss treatment options and implications; support counseling for emotional support; and therapeutic counseling to develop coping strategies. Counseling should be provided before, during, and after ART to address patients' psychological needs. It is important to obtain valid consent, provide full information on risks and outcomes, and handle adverse events sensitively. Effective counseling can help patients navigate the challenges of infertility treatment.
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
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.
THE ASSISTED REPRODUCTION TECHNOLOGY REGULATION RULES, 2010
Members of drafting committee11 members
1- Sr Advocate Supreme Court of India
2 – Public Interest Legal Support and Research
3 – Dept of Family Welfare, M of Fam Wel and Research
5 – experts from the field of Reproductive Medicine
MEDICO LEGAL ISSUES In Infertility & IVF DR. SHARDA JAIN Dr. Jyoti Agarwal ...Lifecare Centre
MEDICO LEGAL ISSUES In Infertility & IVF DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyoti Bhaskar
HISTORY of IVF
THE WORLD FIRST IVF BABY..LOUISE BROWN 25/7/1978
WORLD 2nd but INDIA,s first undocumented IVF BABY..KANUPRIYA [DURGA]…was born
67 days later on 3/10/1978 through effort of
DR SUBHAS MUKHERJEE****Mainly went unnoticed
BABY HARSHA 6/8/1986 …
BOMBAY KEM HOSPITAL + ICMR Effort.
Infertility can be either in male, female, or in both. Dealing with the fact that either of the partner is struggling with infertility, is a difficult task to do. Infertility counselling helps those couples to feel comfortable, accept the fact, and move on with new hope. It help intended parents to understand infertility reasons, further methods to tackle this situation, and finally to become parents.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
The Mental Status Examination [MSE], also referred to as Mental State Examination, is an integral and essential skill to develop in a psychiatric evaluation. Conducting an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factor
Self advocacy is about taking a proactive approach to all stages of health and illness: prevention, diagnosis, treatment, and recovery. When people take an active role in their care, research shows they fare better both in satisfaction and in how well treatments work. In this talk you will learn how to develop the skills to be a good self-advocate, communicate effectively with your doctors, evaluate the latest health news headlines and find the best health information online.
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
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.
THE ASSISTED REPRODUCTION TECHNOLOGY REGULATION RULES, 2010
Members of drafting committee11 members
1- Sr Advocate Supreme Court of India
2 – Public Interest Legal Support and Research
3 – Dept of Family Welfare, M of Fam Wel and Research
5 – experts from the field of Reproductive Medicine
MEDICO LEGAL ISSUES In Infertility & IVF DR. SHARDA JAIN Dr. Jyoti Agarwal ...Lifecare Centre
MEDICO LEGAL ISSUES In Infertility & IVF DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyoti Bhaskar
HISTORY of IVF
THE WORLD FIRST IVF BABY..LOUISE BROWN 25/7/1978
WORLD 2nd but INDIA,s first undocumented IVF BABY..KANUPRIYA [DURGA]…was born
67 days later on 3/10/1978 through effort of
DR SUBHAS MUKHERJEE****Mainly went unnoticed
BABY HARSHA 6/8/1986 …
BOMBAY KEM HOSPITAL + ICMR Effort.
Infertility can be either in male, female, or in both. Dealing with the fact that either of the partner is struggling with infertility, is a difficult task to do. Infertility counselling helps those couples to feel comfortable, accept the fact, and move on with new hope. It help intended parents to understand infertility reasons, further methods to tackle this situation, and finally to become parents.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
The Mental Status Examination [MSE], also referred to as Mental State Examination, is an integral and essential skill to develop in a psychiatric evaluation. Conducting an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factor
Self advocacy is about taking a proactive approach to all stages of health and illness: prevention, diagnosis, treatment, and recovery. When people take an active role in their care, research shows they fare better both in satisfaction and in how well treatments work. In this talk you will learn how to develop the skills to be a good self-advocate, communicate effectively with your doctors, evaluate the latest health news headlines and find the best health information online.
AETCOM (Attitude, Ethics and Communication module)Karun Kumar
Hello friends. In this PPT I am talking about AETCOM (Attitude, Ethics and Communication module) of Pharmacology. If you like it, please do let me know in the comments section. A single word of appreciation from you will encourage me to make more of such videos. Thanks. Enjoy and welcome to the beautiful world of pharmacology where pharmacology comes to life. This video is intended for MBBS, BDS, paramedical and any person who wishes to have a basic understanding of the subject in the simplest way
Generally parents have the autonomy to make health care decisions for their child . In certain situations older children have autonomy to give assent to care& in special situations adolescents are granted a autonomy to consent without parents knowledge.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Dr Sujoy Dasgupta was invited to deliver a lecture on "Male Infertility, Antioxidants and Beyond" on 3 February in Yuvacon 2024 organized by the Bengal Obstetric and Gynaecological Society (BOGS). The session was supported by UNS.
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in an invited debate FOR the motion "Radical excision of DIE in subferile women with deep infiltrating endometriosis is not recommended" in ENDOGYN 2024, organized by the IAGE (Indian Association of Gynaecological Endoscopists) and the BOGS (Bengal Obstetric and Gynaecological Society) on 10 February 2024.
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
Invited lecture by Dr Sujoy Dasgupta in the Ultrasound Workshop of the Annual National Conference of Indian Association of Gynaecological Endoscopists (IAGE) held on 15 March 2024 at the Taj Ganges, Varanasi
Invited lecture by Dr Sujoy Dasgupta on "Azoospermia - Evaluation and Management" in a CME on "Standardising Male Factor Evaluation" organised by Indian Fertility Society (IFS) on 20 January 2024.
Are we giving much importance to AMH in infertility practice?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered "Kamini Rao Oration" on "Are we giving much importance to AMH in infertility practice?" in East Zone Yuva FOGSI Conference organized by Imphal Obstetric and Gynaecological Society (IOGS) on 24 December, 2023
Male Infertility-How a Gynaecologist can Manage?Sujoy Dasgupta
Dr Sujoy dasgupta delivered an invited lecture on "Male Infertility-How a Gynaecologist can Manage?" in a CME on "New Frontiers in Infertility" organized by Genome Fertility Centre and Bhagirathi Neotia Woman and Child Care Centre, Kolkata held on 15 December 2023
Endometriosis and Subfertility, Primium non nocereSujoy Dasgupta
Dr Sujoy dasgupta and Dr Arun Madhab Barua were invited to moderate a panel discussion on "Endometriosis and Subfertility, Primium non nocere" in the International Congress on Endometriosis (ICE) on 10 December 2023 at Dhana Dhanya Auditorium, Kolkata
Dr Sujoy Dasgupta delivered an invited talk on "Embryo Transfer" in "Ultrasound Workshop" on 8 December 2023 at Milan, 2023, the conference of all the Obstetric and Gynaecological Societies of West Bengal. This conference was organized by Kalyani Obstetric and Gynaecological Society (KOGS).
Rational Investigations and Management of Male InfertilitySujoy Dasgupta
Dr Sujoy Dasgupta delivered an invited lecture in the annual conference of WMOGS (West Midnapore Obstetric and Gynaecological Society) held on 16 September, 2023
Endometriosis and Subfertility - What to do?Sujoy Dasgupta
Lecture delivered by Dr Sujoy Dasgupta in IPCON 2823, the Mid term conference of ISOPARB (Indian Society of Perinatology and Reproductive Biology) held at Kolkata on 10 September
IVF- How it changed the perspective of Male InfertilitySujoy Dasgupta
Dr Sujoy Dasgupta was invited to deliver a talk in a CME held on the World IVF Day (25 July, 2023) organized by Burdwan Obst Gynae Society and Corona Remedies.
Male Infertility- How Gynaecologists can manage?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered an invited lecture in a CME organised by JB Pharma with the support from West Midnapore Obst and Gynae Society and Genome Fertility Centre held at Medinipur on 22 July, 2023.
Role of Multivitamins & Antioxidants in Managing Male Infertility Sujoy Dasgupta
Dr Sujoy Dasgupta was invited to deliver a talk on "Role of Multivitamins & Antioxidants in Managing Male Infertility " in a CME organized by Agartala Obstetric and Gynaecological Society and ArEx Laboratory held at Agartala on 8 July 2023
Panel discussion moderated by Dr Sujoy Dasgupta and Dr Sudip Basu on "Troubleshooting in Male Subfertility" in the Andrology Workshop organized by Special Interest Group (SIG) Andrology and Indian Fertility Society (IFS) West Bengal Chapter held on 11 June 2023 at Kolkata
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
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.
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.
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
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
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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The Role of Counselling in IVF
1. Role of ART Counseling
Sujoy Dasgupta
Consultant, Reproductive Medicine,
Genome fertility Centre, Kolkata
2. Why Counselling is Important in ART?
Loss of
• Dream
• Hope
• Future plan
• Marital satisfaction
• Self esteem
• Sense of control
• Privacy
Leads to
• Shock
• Disbelief
• Sadness
• Anger
• Guilt
• Blame
• Depression
3. Stress and ART
• When couples have fertility problems, both partners should be informed that
stress in the male and/or female partner can affect the couple's
relationship and is likely to reduce libido and frequency of intercourse
which can contribute to the fertility problems. (NICE, 2013)
• ART is the most stressful of all Infertility Treatments (80%) (Connolly et al,
Hum Reprod, 1993)
• Women report significantly greater infertility-related anxieties than men
regarding life satisfaction, sexuality, self-blame, self-esteem and avoidance of
friends.(Newton et al, fertil Steril, 1999)
• Unsuccessful treatment raises women’s level of negative emotions (anxiety,
depression and general distress), which continue to persist after consecutive
unsuccessful cycles.
4. Types of Counselling
• implication counselling
• support counselling
• therapeutic counselling
These parts are not separate and
linear but typically overlap.
5. Support counselling
• In this area of counselling, the counsellor offers emotional support
before, during or after treatment, particularly to those experiencing
stress, ambivalence or distress.
6. Therapeutic counselling
• It involves the development of coping strategies to minimise distress
and maximise problem solving, conflict resolution and addressing
specific issues such as sexual, marital and other potential
interpersonal problems.
• It is recommended that the ‘reasonable welfare principle’ be applied.
8. Implication counselling
when an individual or couple seek treatment
1. that will create embryos in vitro
2. to store their gametes or embryos
3. with donated gametes or embryos
4. to donate their gametes or embryos for the treatment of others
or for use in non-medical fertility services/research purposes or
for training people in embryo biopsy, embryo storage or other
embryological purposes.
• This type of decision making and implications counselling includes,
but is distinct from, the more legal concept of informed consent
9. Gamete/ Embryo Donation
• counsellors need to remind all donors
and recipients of the legal aspects
• partners can be the legal parent of any
child born from their partner’s
treatment as long as both have provided
written consent to this prior to
treatment.
• minimum of 2 counselling sessions
should be made available to anyone
considering gamete/embryo donation
and egg/sperm sharing.
10. • Oocyte donors should be offered information
regarding the potential risks of ovarian
stimulation and oocyte collection.
• Oocyte/ sperm recipients and donors should
be offered counselling from someone who is
independent of the treatment unit regarding
the physical and psychological implications of
treatment for themselves and their genetic
children, including any potential children
resulting from donated oocytes.
• Couples should be offered information about
the relative merits of ICSI and donor
insemination in a context that allows equal
access to both treatment options
11. Fertility Preservation
• Cancer Diagnosis
• Social Egg Freezing
• The implications of the posthumous use
of sperm by bereaved women
• focusing on the illness and death of their
loved one
• the likelihood of treatment success
• the psychological welfare of any
potential children
• feelings about the possible disposal of
any remaining gametes
12. Who needs counselling (NICE, UK, 2013)
• Couples who experience problems in conceiving should be seen
together because both partners are affected by decisions surrounding
investigation and treatment.
• People who experience fertility problems should be informed that they
may find it helpful to contact a fertility support group.
• People who experience fertility problems should be offered
counselling because fertility problems themselves, and the investigation
and treatment of fertility problems, can cause psychological stress.
• Counselling should be offered before, during and after investigation
and treatment, irrespective of the outcome of these procedures.
• Counselling should be provided by someone who is not directly
involved in the management of the individual's and/or couple's fertility
problems.
14. Who can counsel
• ART Clinical Nurse
• Patient Educator
• IVF Nurse Coordinator
• Patient Advocate
• Patient Counselor
• Nurse Researcher
• Nurse leader
15. Where to provide Counselling
• Room
• Sitting Arrangement
• Persons in the room
• Dress
• Verbal Communication
• Non-Verbal Clue (e.g. arms uncrossed and
upper body leaning slightly forward,
maintaining good eye contact)
17. Arrival and greeting
• Going to the waiting room to collect the
woman yourself is helpful
• This greeting may simply be by checking the
woman's name and giving your own name.
• Remember to also introduce any other
person(s) in the room.
• Find out who is accompanying the woman
but beware of making assumptions.
• Ensure that she is not staring directly at the
sun and that she can clearly see your face
during the consultation.
20. Information Gathering
• Personal
• Life style
• Medical
• Gain his/ her confidence
• Sexual history
• Information about partner
• Anything he/ she wants to disclose
• Do you need to approach the man/ woman separately
21. How Infertility has affected them
• I never felt that getting pregnant could be so difficult for me
• Pregnancy is a part of my feminine life
• I will never be able to become a mother
• May be, I am taking little more time to fulfil my dream
• People think I am selfish because I am not having baby
• I don’t care what people are saying
• Even cancer patients are getting cured. Why shouldn’t I?
• I know medicine has its own limitations and there is no guarantee.
23. Open question
• Identify the reason for the woman's attendance.
• Open-ended questions often begin with "how", "tell me", "why",
"what" or "describe".
• "I’ve read the referral letter from your doctor but in your own words
can you tell me why you have come today" or "Tell me what is
troubling you".
• Having asked this question it is best to allow the woman to make her
opening remarks without interruption
24. Listening
• appearing interested in the person and what they are saying
• not interrupting the speaker
• avoiding distractions from external events, e.g. telephone calls
• using expressions such as "uh-huh", "yes", "hmm", this will encourage the
woman to go on and convey that you are registering the information,
known as active listening.
• echoing
• clarifying answers and checking understanding
• summarising what has been heard
25. Directing the consultation
• After allowing the woman to tell her story you will need to use
techniques combining open and closed questions to guide her to give
the information you need.
• Another helpful way to demonstrate you are listening and clarify is to
summarise what has been heard, for example, "you say you have tried x
treatment for conceiving but neither of these helped and now you are
thinking something advanced treatment, is this correct?"
26. Explanation and planning
• Patients' concerns usually resolve around one of two broad issues:
1. apprehension about the condition (diagnosis, prognosis, cause)
2. anxiety about the medical care (tests and treatment).
• first find out what the patient already knows
• If the information is complex it is important to reduce it to distinct sections,
e.g., "there are four areas we need to discuss"
• After the explanation, it is pertinent to reflect on whether the his/ her
expectations have been met.
• Once this has been addressed, a plan of management has to be formulated
that is mutually acceptable.
• It is necessary to check that the he/ she is happy with the outcome of the
consultation.
27. Who can take the decision
• Health care provider
• Man
• Woman
• Couple
28. Disseminating Information
• Verbal
• Written- English, Vernacular
• Online links
• Support groups
• Fact sheets- Individual conditions
• Tip sheets- treatment decided
• Summary sheets- Patient oriented
31. Financial Aspect
• Too costly affair
• Can’t you consider my case
“The cost (with suitable break-up) to the patient of the treatment
proposed and of an alternative treatment, if any (there must be no
other ‘hidden costs)” (ICMR)
34. Valid Consent
The patient must have capacity to make an informed decision:
• considered competent to give consent
• able to understand information provided
• Able to retain the information
• can communicate their decision
Consent must be provided voluntarily:
• In most cases the decision to provide or withhold consent should be by the patient themselves.
• The patient should not be coerced or influenced by carers, family or friends.
The patient should be fully informed of the following by carers with enough time allowed to reflect
and ask questions:
• benefits and risks of the intended procedure
• alternative management strategies
• implications of not undergoing the proposed treatment.
35. The proposed procedure
• medication
• anaesthesia
• pain
• recovery
• Examination of intimate area
• likely impact on daily and personal life (e.g. time off work, driving, lifting,
sexual activity)
• video, photographic and digital record-keeping
• Additional procedure that may be required- TESE, Mock ET, ET under
anaesthesia, freezing, blastocyst, PGS
• What procedure should not be done
• Specific circumstances
36. Risks
Serious risks
• trauma to bowel, bladder, ureter
and major blood vessels
• Bleeding
• OHSS
• Infection
• death (if considered appropriate
to inform the patient during the
consent process)
• return to theatre
Frequent risks
• Pain
• Soreness
• bruising
• Failure to retrieve the eggs/
sperms
• Failure of fertilization
• Failure of the embryo to survive
the freeze-thaw process
37. Long-term health outcomes and safety of IVF
• No direct association has been found between these treatments and invasive cancer
but a small increased risk of borderline ovarian tumours cannot be excluded.
• No association has been found in the short- to medium-term between these
treatments and adverse outcomes (including cancer) in children born from ovulation
induction / IVF
• The absolute risks of long-term adverse outcomes of IVF treatment, with or without
ICSI, are low.
• Information about long-term health outcomes in women is still awaited.
• Despite the fact that the treatments have been established practice for over 40 years, the
longest length of follow-up in the studies reviewed was 20 years, and the larger studies
had shorter follow-up periods.
38. • The basis, limitations and possible outcome of the treatment proposed, variations in its
effectiveness over time, including the success rates with the recommended treatments obtained
in the clinic as well as around the world (this data should be available as a document with
references, and updated every 6-12 months).
• The possible side-effects (e.g. of the drug used) and the risks of treatment to the women and
the resulting child, including (where relevant) the risks associated with multiple pregnancy.
• The need to reduce the number of viable foetuses, in order to ensure the survival of at most two
foetuses.
• Possible disruption of the patient’s domestic life which the treatment may entail.
• The techniques involved, including (where relevant) the possible deterioration of gametes or
embryos associated with storage, and possible pain and discomfort.
• The importance of informing the clinic of the result of the pregnancy in a pre-paid envelope.
• The advantages and disadvantage of continuing treatment after a certain number of attempts.
41. Something went wrong
• A minor mistake- a mistake that did not cause added problem for the
woman but corrective action should have been undertaken.
• A moderate mistake- caused additional suffering to the woman but was
not life threatening.
• A serious error- resulted in the death of the woman or a 'near miss'.
42. Issues to be considered when something goes wrong
• Informing the woman
There is recent evidence that women would prefer to know if they had been subject to
a medical error, even though they had not suffered any adverse effects.
• Informing seniors
Undoubtedly, it is best to be honest about mistakes, sharing the fact that it has
occurred with a senior colleague.
This will allow reflection on why the error occurred and how it can be avoided in future.
• Apologising
An apology is often all that the woman wants. This does not constitute an admission
of guilt.
43. Breaking Bad News (BBN)
A commonly used model for BBN is Kaye's model (1996).
1. preparation
2. what does he/ she know?
3. is more information wanted?
4. give a warning shot
5. allow denial
6. explain if requested
7. listen to concerns
8. encourage ventilation of feelings
9. summarise and plan
10. offer further information.
45. “Difficult” Patients
• I want to do it now
• I want to undergo this treatment only
• I cannot wait for long time
• I want to see Dr X only and that’s now
• I want to make complaint against the service/ staff Y
• Why I was not told about it
• It’s your fault. That’s why my treatment failed.
46. Documentation
• Information Collected
• Sensitive Information- ?
• Discussion
• Investigation/ Treatment offered
• Merits and demerits
• Risks
• Agreed/ disagreed
• Any specific concerns
47. What clinics can do
• Waiting areas- access to reading materials, water, restrooms
• Private rooms for consultation/ counselling
• Billing and scheduling- confidential manner
• Sample collection room
• Private recovery area
• Bereavement counselling
• Patient Advocate/ Ombudsman
• Patient surveys/ suggestion box/ open feedback
48. How Effective the Counselling is
• Typically, the literature quotes an average rate of 20% for uptake of
counselling within the field of infertility, with higher uptake by
participants with higher levels of education, and by those from the
middle and upper classes than by participants from lower social
classes. ( Joy et al, The Obst and gynaec, 2015)
49. How to improve your skill
• If your mind does not know………..
• Training
• Seeing others doing
• Practice
• Role Player