Vision FOGSI 2020 - BY Dr Dhorepatil Bharati
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Respected Seniors & Friends please VOTE your candidate as FOGSI PRESIDENT - DHOREPATIL BHARATI
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Ovulation Stimulation Protocols for IUI
This document discusses mild ovarian stimulation protocols for ovulation induction and in vitro fertilization (IVF). It outlines important factors to consider like ovarian reserve, previous response, and hormone profiles. It compares protocols using clomiphene citrate, aromatase inhibitors, and gonadotropins alone or in combination to induce ovulation of 1-3 follicles. Premature luteinization during ovarian stimulation is also discussed. The document aims to develop cost-effective low-dose IVF procedures suitable for developing countries like India.
Unexplained Infertility - By Dr Dhorepatil Bharati
Diagnosis.. Catch them Young
Investigation..Optimize
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Long term consequences..is there enough evidence?
Practical considerations
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The document discusses guidelines and recommendations for ovarian drilling as a treatment for polycystic ovary syndrome (PCOS). It recommends that ovarian drilling be used as a second-line treatment in highly selected cases, such as those with clomiphene citrate resistance, a normal body mass index, or who live too far from treatment centers. The document provides guidance on patient selection, including optimal anti-Mullerian hormone levels, as well as techniques for ovarian drilling to optimize outcomes and avoid potential risks like diminished ovarian reserve. Key aspects discussed include tailoring the number of punctures and thermal dose based on individual ovarian volume.
Unexplained Infertility - By Dhorepatil Bharati
Diagnosis.. Catch them Young
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Ovulation Stimulation Protocols for IUI
This document discusses mild ovarian stimulation protocols for ovulation induction and in vitro fertilization (IVF). It outlines important factors to consider like ovarian reserve, previous response, and hormone profiles. It compares protocols using clomiphene citrate, aromatase inhibitors, and gonadotropins alone or in combination to induce ovulation of 1-3 follicles. Premature luteinization during ovarian stimulation is also discussed. The document aims to develop cost-effective low-dose IVF procedures suitable for developing countries like India.
Unexplained Infertility - By Dr Dhorepatil Bharati
Diagnosis.. Catch them Young
Investigation..Optimize
Management..How long?
Long term consequences..is there enough evidence?
Practical considerations
Genetic & Epigenetic Factors
“Inheritance” in images, from Darwin’s “tree of life” to DNA’s iconic crystallography to the epigenetic dynamics However, the script needs to be interpreted and receives meaning only from the interplay with the environment
Medico Legal Aspects of ART - Dr Dhorepatil Bharati
THE ASSISTED REPRODUCTION TECHNOLOGY REGULATION RULES, 2010
Members of drafting committee 11 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
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The document discusses guidelines and recommendations for ovarian drilling as a treatment for polycystic ovary syndrome (PCOS). It recommends that ovarian drilling be used as a second-line treatment in highly selected cases, such as those with clomiphene citrate resistance, a normal body mass index, or who live too far from treatment centers. The document provides guidance on patient selection, including optimal anti-Mullerian hormone levels, as well as techniques for ovarian drilling to optimize outcomes and avoid potential risks like diminished ovarian reserve. Key aspects discussed include tailoring the number of punctures and thermal dose based on individual ovarian volume.
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Diagnosis.. Catch them Young
Investigation..Optimize
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Practical considerations
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Maintenance of pregnancy
Corpus luteum Progesterone
After ovulation ~ during the early first trimester ~ until placental function established
Removal of the corpus luteum spontaneous pregnancy loss
Ovarian progesterone production implantation & early pregnancy
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The achievement of a pregnancy with no OHSS, leading to a singleton live term birth of a healthy child.
PCOS - Ovulation Induction 2 - Dr Bharati Dhorepatil
31yrs old, married 7yrs, wt 50.5, BMI 23.37
Semen parameter..80 millions,80% motility
Hormonal Parameters…FSH 6.82,LH 13.45,TSH 0.64,Prolactin 16ng/ml, Free Testesteron 45.72, AMH 13ng/ml
TVS findings…PCOM…with Rt AFC 20 and Lt.25 follicles
Clinical side.. H/0 irregular cycles.(3 to 4 /yrs)
Acne gr III, Hirsutism FG Score 8
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Heterogeneous, reproductive-metabolic,pathological disorder
Primary cause: Ovarian androgen overproduction
Associated with insulin resistance and obesity
Androgens and Ovarian Response
Role of decreased androgens in the ovarian response to stimulation in older women
Part I: Effects of testosterone (T) on preantral and antral follicles
Part II: How to improve ovarian response ?
Exogenous testosterone
DHEA
Aromatase inhibition (AI)
LH/HCG
Growth hormone (GH) / IGF-I
Indivisualization of Ovulation Induction - Dr Dhorepatil Bharati
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
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MONITORING PITUITARY DOWN-REGULATION
If GnRH Agonist is started in the late luteal phase a menstrual bleeding normally indicates that the estrogen is low and FSH can be started.
Blood tests will clearly confirm down-regulation – ovarian/pituitary hormones.
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil Bharati
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
Controlled Ovarian Hyperstimulation With IUI
Patient selection and work-up
Ovarian stimulation
Monitoring of follicular growth and endometrial development
Timing of insemination
Number of inseminations
Semen preparation
Insemination procedure
Luteal support
Ovulation Induction - Simplified - Dr Dhorepatil Bharati
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
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Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
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WHO classification
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Drugs
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Complications
Take home messege
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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
Progesteron & Estrogen - Clinical Applications - Dr Dhorepatil Bharati
Progesterone and estrogen are essential hormones in the female reproductive system that work together to control uterine function and facilitate reproduction. Progesterone plays a central role in producing a receptive uterus capable of supporting pregnancy in post-menopausal women receiving donor embryos. Progesterone levels decline dramatically during menopause. Progesterone deficiency can lead to abortion, and supplementation with progesterone has been shown to significantly reduce miscarriage rates in women with recurrent pregnancy loss or threatened abortion.
Egg freezing - Dr Dhorepatil Bharati
1) Assisted reproductive techniques like egg freezing allow women to preserve their fertility for medical or social reasons.
2) Freezing eggs through vitrification has improved significantly and can provide pregnancy success rates similar to fresh eggs.
3) While egg freezing is accepted to preserve fertility for young cancer patients, there is debate around its use for social reasons due to concerns about unrealistic expectations of future fertility and the ethics of commercializing human eggs.
Egg freezing - Dr Dhorepatil Bharati
1) Assisted reproductive techniques like egg freezing allow women to preserve their fertility for medical or social reasons.
2) Freezing eggs through vitrification has improved significantly and can provide pregnancy success rates similar to fresh eggs.
3) While egg freezing is accepted to preserve fertility for young cancer patients, there is debate around its use for social reasons due to concerns about unrealistic expectations of future fertility and the ethics of commercializing human eggs.
Mangment of Infertility
This document outlines an action plan for the prevention, detection, and management of infertility. It discusses the need for such a plan given infertility is a growing public health issue. The plan aims to improve access to diagnosis and treatment through primary, secondary, and tertiary prevention approaches. It also seeks to establish low-cost in vitro fertilization to help more people address infertility issues. Key factors that influence infertility treatment costs and outcomes are identified. Prevention strategies target conditions like sexually transmitted infections that can lead to tubal damage. The role of lifestyle factors in both causing and treating infertility is addressed. Diagnostic tools and assisted reproduction techniques are outlined along with when each is most appropriate. Challenges in making these services accessible in developing countries are
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Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
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This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
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By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
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TVS findings…PCOM…with Rt AFC 20 and Lt.25 follicles
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Blood tests will clearly confirm down-regulation – ovarian/pituitary hormones.
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Basic hormone profile
Role of LH
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Patient selection and work-up
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Number of inseminations
Semen preparation
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Luteal support
Ovulation Induction - Simplified - Dr Dhorepatil Bharati
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
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Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
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Focus Points of Discussions
WHO classification
Basic concepts
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Drugs
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Why we need to predict?
Hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis
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Progesteron & Estrogen - Clinical Applications - Dr Dhorepatil Bharati
Progesterone and estrogen are essential hormones in the female reproductive system that work together to control uterine function and facilitate reproduction. Progesterone plays a central role in producing a receptive uterus capable of supporting pregnancy in post-menopausal women receiving donor embryos. Progesterone levels decline dramatically during menopause. Progesterone deficiency can lead to abortion, and supplementation with progesterone has been shown to significantly reduce miscarriage rates in women with recurrent pregnancy loss or threatened abortion.
Egg freezing - Dr Dhorepatil Bharati
1) Assisted reproductive techniques like egg freezing allow women to preserve their fertility for medical or social reasons.
2) Freezing eggs through vitrification has improved significantly and can provide pregnancy success rates similar to fresh eggs.
3) While egg freezing is accepted to preserve fertility for young cancer patients, there is debate around its use for social reasons due to concerns about unrealistic expectations of future fertility and the ethics of commercializing human eggs.
Egg freezing - Dr Dhorepatil Bharati
1) Assisted reproductive techniques like egg freezing allow women to preserve their fertility for medical or social reasons.
2) Freezing eggs through vitrification has improved significantly and can provide pregnancy success rates similar to fresh eggs.
3) While egg freezing is accepted to preserve fertility for young cancer patients, there is debate around its use for social reasons due to concerns about unrealistic expectations of future fertility and the ethics of commercializing human eggs.
Mangment of Infertility
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Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
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This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
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This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
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