Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
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
Role of Calcium in pregnancy DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Rashmi Jai...Lifecare Centre
ROLE OF CALCIUM IN PREGNANCY
FOCUS :
Daily requirement of calcium according to age
Calcium metabolism in pregnancy
Calcium requirement in pregnancy
Maternal benefits
Fetal benefits
Reduction in blood lead levels
Nutrition to improve calcium
Guidelines about dietary calcium intake / supplements in pregnancy
PCOD,How are they different ??Difficulties & Solutions made Easy , Dr. Sharda...Lifecare Centre
Tremendous advances and extensive human studies have uncovered the complexity and management of PCOD
Global prevalence -2.2% to 26% Roughly 1 in 15 women worldwide, (Lancet, 2007)
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.
Adjuvant therapy, also known as adjunct therapy or add-on therapy, is therapy given in addition to the primary or initial therapy to maximize its effectiveness.
Add-ons have become ubiquitous with the process of assisted reproduction (ART) which is markedly more complex than it was at its inception.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
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
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Platelet-rich plasma (PRP) has become popular as a non operative treatment option for a broad spectrum of medical disorders. There are reasonable amount of data which warrant continued research in PRP but currently its role in clinical practice is not completely defined. Prior to its use, special consent is required after an honest and open discussion with the patient as well controlled human studies are lacking
Healthy Choices are the key!
Healthy diet including raw foods & avoiding processed food or high fat diet is the best way to eliminate toxins from your body. Toxins damage your egg follicles.
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
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.
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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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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.
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
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.
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
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
3. Healthy seed in not enough to get a
healthy sapling unless it grown on
fertile soil.
Similarly healthy embryo needs
receptive endometrium for successful
implantation.
Hard Facts
4. Optimum endometrium i.e. 7
mm preovulatory is must for
achieving pregnancy –
Management of This
endometrium is challenging
problem for infertility experts
There is no consensus regarding
management of
thin endometrium found at
the time of
ovulation induction in IUI &
IVF.
Treatment of
Thin endometrium in infertility
5. Important causes of poor endometrium
growth during ovulation induction are:
Endometrial resistance to oestrogen.
Reduced blood flow.
Over -exposure to testosterone.
Permanent damage to the basal
endometrium
Causes of Thin Endometrium
6. Based on aetiology, number of
drugs/methods
has been used with aims of
improvement
oestrogen level in endometrium and
increase
blood supply to basal endometrium.
Principle of Treatment of
thin Endometrium in infertility
8. In the group of patients where clomiphene
induction is associated with thin
Endometrium,
LETROZOLE
TAMOXIFEN
Can be alternative drugs
Use Alternative drugs to
clomiphene induction
Letrozole / Tamoxiten
9. However, these drugs remain
off – label for ovulation
induction and hence cannot
be recommended at present.
Use for ovulation induction with
LETROZOLE / TAMOXITEN
have the advantage of avoiding
peripheral anti estrogenic effects.
10. OESTROGEN – is second
alternative
In this group of patients, addition of
oestrogen is seen as the logical step in
combating antiestrogenic effect on
endometrium.
However, the dose, the regimen and type
of oestrogen used vary widely with little
consensus to the treatment approach.
11. In a meta-analysis done by Torres RF et al
examined the use of pure ethinyl estradiol
(EE) for treatment of thin endometrium,
observed that use of Ethinyl estradiol 0.02-
0.05mg/day given from 7th day of cycle for 5
days, does improve the endometrial thickness
in comparison to patients where only placebo
was used.
Torres R.F, A Meta-Analysis. Fertil steril 2005; 84:S162-S163
The Famous Meta analysis
On oestrogen use
12. Other oestrogen preparation and
dose schedule reported in
literature are :
Conjugated equine
Oestrogen :
0.625 mg from day 7TH
FOR 5 DAYS.
Transdermal ethinyl
Oestradiol :
4 mg / day from day 8th
till
the day of ovulation
Vaginally administered
Local estrogen :
To avoid the first pass of
systemic oestrogen
13. OESTROGEN USED
VAGINALLY
Kadir Cetinkaya et al used vaginally
administered local oestrogen 25mcgms from
4th
day for 15 days in CC induced cycle. They
reported significant increase in ET on the
day of ovulation (7.6 +/-1.4 mm vs 8.3+/-2.1
mm) than the group where only CC was
used, but there was no change in pregnancy
rate.
Cetin kaya k e al Ja. Tuk . Ger. Gynaecol. Assoc 2012 , 13CB), 157-61
14. ORAL OESTROGENS
Oral oestrogens are now routinely used for
preparation of endometrium for frozen embryo
transfer, where previous IVF failure was thought
to be due to thin endometrium.
Dose schedule is different from fresh cycle. Most
use oral estradiol 2mg thrice daily from day one
for 12 days.
The appropriate development of endometrium in
seen in good 70 – 80 % cases
15. Few IVF experts use step wise increased
dose of oestradiol, 2mg/day from Ist to
4th
day , 4 mg from 5th
to 8th
day and 6 mg
from 9th
to 12th
day of cycle and reported
better ET development.
Oestrogen is also found to improve
blood circulation to radial artery which is
evident by improved flow in radial
artery.
ORAL OESTROGENS
16. Vitamin EVitamin E the dose of 600 mg / day (200 mg three
times daily ) orally given throughout the menstrual
cycle to improve ET.
Akihisa Takasaki et al observed adequate ET in 52%
patients following treatment. 72% showed improved
RA – RI and 20 % conceived. Each of these parameters
registered statically significant improvement when
compared to previous untreated cycle.
Vitamin E improves growth of the glandular
epithelium and number of blood vessels VEGE protein
expression.
Takasaki A et al ferpil . Stoni 2010, 93 (6) 1851 -8
17. L arginine treatment :
Akihisa Takasaki et al tried L arginine in patient
with thin endometrium at the dose 1.5gms
four times (6gms) from ist day till the day of
hCG injection. It improved RA-RI in 89% of
patients and 67% patients developed
endometrium more than 8 mm this
difference was statistically significant when
compared to previous cycle in these patients.
Takasaki A et al ferpil . Stoni 2010, 93 (6) 1851 -8
18. SILDENAFIL CITRATE
Sildenafil citrate, a type 5 – specific
phosphodiesterase inhibitor, augments the
action of Nitric Oxide on vascular smooth
muscle.
It is thought to improve uterine blood flow
and along with oestrogen -- leads to
oestrogen induced proliferation of
endometrial lining.
19. Tumor suppressor factor (p53), Plasminogen
activator inhibitor 1 (PAI – 1), and Vascular
endothelial growth factor (VEGF) need to
produced necessary to digest the endometrial
cellular matrix to regulate cell growth and
angiogenesis to facilitate implantation.
Sildenafil citrate markedly enhanced p53 ,PAI – 1
with increased VEGF.
Sildenafil Citrate
20. Many studies have been
conducted to evaluate the role of
sildenafil to improve THIN
ENDOMETRIUM in patients of
infertility
21. Study Dose
of
Silden
afil
Duration of
therapy
Mode of
administ
ration
Results
Takasaki et al 2 100 mg Ist day till day of
ovulation
Intravaginal 92% patients showed
improvement in endometrial
thickness andd RA – RI
Intravaginal route reduces side
effects llike headache and
hypotension.
Firouzabadi et al
6
50 mg Ist day till 45-72 hours
prior to embryo
transfer
Oral Endometrial thickness and
triple line pattern significantly
higher with sildenafil and
estadiol valerate as compared
to estradiol alone clinical
pregnancy rate was higher but
not significant
Malgorzata
Jerzak et al7
2.5 mg X
four
Times a
day
3-6 days Intravaginal
Suppostory
Endometrial thickness was
significantly increased Dose
independent reduction in NK
cell activity Successful use of
sildenafil in two infertility
patients with Asherman
22. Pentoxifyline• Pentoxifyline, a xanthine
derivative, which is primarily used
in medicine for treatment of
Intermittent Claudication resulting
from peripheral arterial disease
has also been tried to increase
endometrial circulation--- with no
conclusive result
23. Micronized low dose
ASPIRIN
Micronized low dose aspirin
has been tried left and right
But no randomised trial is
available literature to show
whatever it is worth white !!
24. GRANULOCYTE COLONY
STIMULATING FACTOR
(GCSF )-- A new promise
G-CSF has shown potential of improving
ET in patients with poor endometrial
growth especially when it is due to
destruction of subendothelial layer
where other common treatment for
vasodilatation have failed.
Gleicher in et all Fertil . Senl 2011, 95(6)2123
25. Norbert Gleicher et al 2011 was the first to use it
in four patients with dramatic improvement in
ET.
Various reported studies are shown in next slide
but this is still in experimental stage and it
needs more well planned research with large
sample size to be able to recommend it as a
standard treatment.
Granulocyte colony stimulating
factor (GCSF ) new promise
Gleicher in et all Fertil . Senl 2011, 95(6)2123
26. Evaluation of the role G-CSF in thin endometrium
Study Dose of GCSF Duration of therapy Results
Nobert
Gleicher et al
2011 8
1 ml 30 MU
(300mcg)
2-7 days before embryo
transfer (ET)by ET catheter
Dramatic improvement in
endometrial thickness all
four patients conceived with
one intramural ectopic
pregnancy.
Y Kim et al
2012
1 ml 30MU
(300mcg)
On the day of hCG injection Significantly higher
endometrial thickness (85%
showed improvement),
implantation and ongoing
pregnancy rate
Maryam
Eftekhar
2014
1 ml 30 MU
(300mcg)
12th
– 13th
day of cycle but
repeated once more if
endometrial thickness below
7 mm within 48 – 72 hours.
No difference in endometrial
thickness
Chemical pregnancy rate and
clinical pregnancy rate were
found to be better
(39.30%vs, 14.30% &
32.10%vs. 12.00%
respectively ) Not
statistically significant
27. NEUROMUSCULAR ELECTRICAL
STIMULATION and biofeedback
therapy is another very recent
experiment on improvement of poor
endometrial growth.
However , more work need to be due.
28. Endometrial scratch
Few randomized controlled trial
has shown that endometrial
scratching in the luteal phase of
one cycle prior to IVF CYCLE
INCREASES PREGNANCY RATE
29. RATIONALE of
endometrial scratch
Tissue injury procedures like
endometrial biopsy or hysteroscopy
in the cycle prior to IVF treatment
induces stem cell differentiation
and increases the endometrial
receptively during the IVF treatment
cycle.
Most expert doing IVF & IUI have started doing it.
30. Endometrial Reconstruction
with Stem cell therapy
Ideal candidates
The patients with persistent thin
endometrium with repeated
implantation failure.
Treated cases of tuberclosis with thin
endometrium
Asherman syndrome grade III are the
patient who need it most
31. Recent case report of endometrial
reconstruction using autologous
bone Marrow stem cells followed by
conception by IVF in two patients
has gained considerable attention
and seems to provide ‘break
through’ for conception in IVF cycle.
Stem cell and thin
endometrium
32. Life care IVF
We have used autogous stem
cells therpy along with use of
stem cells in locally in the
endometrium in 2 cases.
In both cases endometrial
growth was 8 mm plus &
pregnancy occurred in one
33. Dr. Manjula Agnani (Padamshree)
from Hyderabad
Personal communication to Dr. sharda jain
Autologous stem cells therapy from bone
marrow was used in 4 cases of refractory
thin endometrium
All four responded with endometrial growth
8 mm plus.
34. ConclusionEvaluation and detection of any endometrial
abnormality is one the cornerstone in the
management of infertility
Optimum endometrium thickness i.e. 7 mm
preovulatory is must for achieving pregnancy
Various modalities have been studied for
improving the endometrium (thickness and
vascularity)
35. -- But treatment modalities for
achieving adequate endometrium
this are still evolving
G-CSF, endometrium scratch &
stem cells therapy are new entry
Conclusion
36. ADDRESS
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