The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
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
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
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
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
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
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
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
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
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
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 .
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
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
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
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
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 .
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Endometrial cancer in a woman undergoing hysteroscopy for recurrent ivf failurecare women scentre
Are you Search for Best fertility hospital in indore? Care Womens Centre is India's one of the Best fertility hospital and Test tube baby centers in Indore. Care Womens Centre offers excellent treatment for IVF, ICSI, IUI, Test tube baby treatment and infertility treatment in indore. Care Womens Centre, Madhya Pradesh, India.
Book an appointment https://www.carewomenscentre.com and call us 8889016663.
International Journal of Pharmaceutical Science Invention (IJPSI) inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
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.
Poly-cystic ovarian syndrome is am emerging problem in an adolescent age group which needs to be addressed because of different diagnostic criteria in this age group.
May occur very early on during the attachment or migration stages (No objective evidence e.g. –ve hCG)
May also occur at a later stage (+ve hCG) but process becomes disrupted
Definition: Refers to the failure of the embryo to reach a stage when an intrauterine gestational sac is recognized by ultrasonography.
Implantation failure can apply to patients undergoing ART and patients trying to conceive without any fertility treatment.
It is a separate entity from RPL
Orvieto et al - 3 failed IVF-ET cycles with good quality embryos transferred .
Zeyneloglu et al. - 3 unsuccessful IVF specifically with two embryos of high quality
Simon and Laufer - embryo & endometrium can both play an active role in RIF
Coughlan et al. suggest a more complete working definition taking into account maternal age, number of embryos transferred, and number of cycles completed.
They define RIF as the failure of clinical pregnancy after 4 good quality embryo transfers, with at least three fresh or frozen IVF cycles, and in women under the age of 40
RIF is a complex problem with a wide variety of etiologies / mechanisms/ treatment options.
Recommendations vary depending on the source of their problem. Perhaps the best and yet most complex answer is personalized medicine, a personal approach to each patient depending on her unique set of characteristics.
It would help to establish a set of standardized tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
This can be implemented when we have well designed studies that will help us to establish new protocols.
Recent evidence based guideline regarding Ovarian drilling very helpful for Gynaecologist, laparoscopic surgeon, Infertility specialist, Post doctoral fellows and post graduates
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
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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.
Follow us on: Pinterest
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
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
1. 9/3/2022
WHAT IS NEW IN
ESHRE 2022 CONFERENCE
&
FIGO 2022?
For General Gynecologist
Prof. Aboubakr Elnashar
Benha university hospital
ABOUBAKRELNASHAR
97 sessions:
317 oral presentations
801 poster presentations
1. Keynote Session: 1
2. Plenary sessions: 10
3. Communication sessions: 37
Session: ART in times of war in Europe .
ABOUBAKRELNASHAR
2. MALE INFERTILITY
Male fertility testing - new horizons, ideas & research
A. Salas-Huetos
Limitations of the current semen analysis
Alternative diagnostic approaches that effectively predict fertility
in men is urgently needed
Novel tests are available & more important the new horizons,
ideas & research in male fertility testing.
1. Sperm functionality analyses
Plasma membrane & acrosome integrity, plasma membrane
lipid disorder, mitochondrial membrane potential,
Mitochondrial peroxide and superoxide levels, intracellular
levels of ROS and Ca2þ, sperm chromatin condensation
ABOUBAKRELNASHAR
2. The newest recommendations of European Association of
Urology 2021:
SDF testing should be performed in RPL, or men with
unexplained infertility (Normal semen parameters) (strong recommendation)
Varicocelectomy may be considered in men with raised SDF
with otherwise unexplained infertility or who have suffered
from RPL, RIF (weak recommendation)
3. The newly described monogenic causes (regulated by one gene or one
of a pair of allelic genes) of male infertility Next-Generation Sequencing:
increasing number of monogenic causes of male infertility
ABOUBAKRELNASHAR
The MiOXSYS System: This device measures ORP using only a galvanostatic
MiOXSYS analyzer (A) and disposable sensor strips (B).
ABOUBAKRELNASHAR
Predictive value of seminal oxidation-reduction potential
(ORP) and SDF analysis for reproductive outcomes of ICSI
Cycles
A. Morris et al
Both SDF & seminal ORP have strong prognostic value in
predicting
good fertilization (80%),
blastocyst development (60%),
CPR & LBR
ABOUBAKRELNASHAR
2. 9/3/2022
Sperm count is increased by diet-induced weight loss and
maintained by exercise or GLP-1 analogue treatment: RCT
Andersen et al
An 8-w low-calorie diet-induced weight loss:
improved sperm count, which was maintained after one year
in men who maintained weight loss.
ABOUBAKRELNASHAR
3. ENDOMETRIOSIS
Pathophysiology of endometriosis– what’s new?
H. Taylor.
E is defined as a ch. gyn disease characterized by endometrial-
like tissue present outside of the uterus & is thought to arise by
retrograde menstruation.
However, this description is outdated & no longer reflects the
true scope & manifestations of the disease.
E is now considered a systemic disease rather than a disease
predominantly affecting the pelvis.
E: affects metabolism in liver & adipose tissue: systemic inflammation
alters gene expression in the brain: pain sensitization &
mood disorders. ABOUBAKRELNASHAR
ABOUBAKRELNASHAR
Recognition of the full scope of the disease will facilitate
diagnosis & allow for more comprehensive TT
Progestins&low-dose COC are unsuccessful in a third of
symptomatic women {progesterone resistance}.
Oral GnRHan
An effective & tolerable alternative when 1st line medications
do not work
Fewer side-effects than other therapies
Optimize& personalize endometriosis care.
ABOUBAKRELNASHAR
Impact of endometriosis on the oocyte
C. Racowsky et al
Women with E tend to have lower implantation rates
than those without E.
Whether this is due to compromised endometrial
receptivity or reduced embryo quality remains
controversial.
Studies support the conclusion that oocyte quality is the main
factor compromising implantation rate.
This conclusion is consistent with documented elevations of
inflammatory cytokines, ROS & growth- and angiogenic factors
in follicular fluid&peritoneal fluid of women with E.
ABOUBAKRELNASHAR
Endometrioma & fertility preservation: how can we save
the oocytes. J. Donnez
Fertility preservation is a major challenge when therapeutic
approaches of ovarian endometrioma are planned.
How to preserve fertility in women at risk of POI due to severe
&/or recurrent ovarian E? Two main options:
1. COS,ovum pick-up & vitrification of oocytes: high cumulative
LBR in women ≤35 y: patients with endometrioma should be
encouraged to freeze oocytes at a younger age.
2. Orthotopic* auto transplantation of cryopreserved ovarian
cortex (which has led to ≥200 live births ) could be proposed to
maintain the follicular pool.
*Grafting of tissue in a natural position
ABOUBAKRELNASHAR
3. 9/3/2022
Evidence based management of endometriosis – what has
changed since 2013? C. Becker
Laparoscopy is no longer the gold standard for E
TVS performed by an experienced operator or MRI can equally
identify or rule out ovarian & most of deep E.
Ultralong protocol is not recommended
GnRHan seem to be effective in TT of E-associate pain&,
where available, could be considered as 2nd-line TT
Specific chapters on
E in adolescents and in menopausal women
Association of E with certain forms of cancer namely
subgroups of ovarian, breast & thyroid cancer
ABOUBAKRELNASHAR
4. FIBROID
To remove or not to remove - debate continues
K.D. Nayar
Both size & distance of F. from endometrial cavity are important
factors, which determine the effect of intramural F on fertility.
The production of transforming growth factor is increased as
size of F increases: impairs the endometrial receptivity.
F. causing menorrhagia are likely to affect end receptivity.
Myomectomy on intramural F should be individualized
Prior to ART cycle in women with
Reduced ovarian reserve,
Advanced maternal age,
RPL or RIF ABOUBAKRELNASHAR
The effect of the presence of intramural Fibroid smaller
than 6 cm on reproductive outcome in IVF treatment: a
SR and MA
E. Uyanık et al
Non-cavity-distorting intramural myomas with the size of<6 cm
have a significant adverse effect on reproductive outcomes in
IVF.
ABOUBAKRELNASHAR
BMI is not associated with ovarian
response to gonadotropin during IVF/ICSI: An
evaluation of 4499 IVF/ICSI cycles
C.G. Petersen et al.
BMI does not seem to be associated with the ovarian response
to gonadotropin.
ABOUBAKRELNASHAR
Cancer in Children Born after Frozen-Thawed ET: A Cohort Study
N. Sargisian et al.
Children born after FET have a higher risk of childhood cancer
than children born after fresh ET and spontaneous conception.
This large Nordic registry-based cohort study included 171 774 children born
after use of ART and 7 772 474 children born after spontaneous conception
during a study period of up to three decades (Denmark, Finland, Norway, Sweden).
For cancer subgroups, higher risks of
epithelial tumours and melanoma after any ART
leukaemia after FET.
Incidence rate (IR) of any cancer before 18 y of age /100 000 person-years after
Spontaneous conception ART Fresh ET FET
16.7 19.3 18.8 30.1
ABOUBAKRELNASHAR
8. RPL
Subclinical hypothyroidism & antithyroid autoantibodies
in women with subfertility or RPL
R. Dhillon-Smith et al
Untreated mild–moderate SCH (TSH 4.0-10.0mIU/l):
Early pregnancy loss
LT4 TT: improved pregnancy & LBR (low quality evidence)
Routine preconception TSH & fT4 testing should be offered to
women with history of
RPL or
women undergoing ART
Once pregnancy: women receiving LT4 TT for SCH:
An empirical dose increase, doubling the dose on 2 days/w
Regular TSH measurements from 7–9 W gestation.
ABOUBAKRELNASHAR
4. 9/3/2022
Euthyroid TPO Ab-positive
No benefit from LT4 TT women
Thyroid function monitoring during pregnancy.
Further studies are required to determine the role of
selenium or steroids in improving pregnancy outcomes
ABOUBAKRELNASHAR
10. OTHERS
Does advanced paternal age influence LBR independent of
woman’s age: analysis of 18, 825 fresh IVF/ICSI cycles from a
national (HFEA) database
A.K. Datta
LBRs decline with paternal age 40 ys, but not when female
partner is<35 or40 ys.
ABOUBAKRELNASHAR
The pregnant outcome after laparoscopy treatment for
subtle distal fallopian tube abnormalities in infertile population:
a prospective cohort study
Zheng et al
Subtle distal fallopian tube abnormalities: Fimbrial agglutination,
tubal diverticula, accessory ostium, fimbrial phimosis, and
accessory fallopian tube.
The natural pregnancy rate is 46.58% after laparoscopy TT
ABOUBAKRELNASHAR
Comparing LNG-IUS 52mg vs hysteroscopic resection
in patients with postmenstrual spotting related to a niche in the
caesarean scar (MIHYS NICHE Trial)
D. Zhang et al.
At the 6th month after TT, the median total bleeding days after
LNG-IUS 52mg was 4 days, shorter than 13 days after
hysteroscopic niche resection.
ABOUBAKRELNASHAR
The FIGO
Ovulatory Disorders Classification
System, 2022
Prof. Aboubakr Elnashar
Benha university Hospital, Egypt
ABOUBAKRELNASHAR
WHO types of anovulation, 1973
Modified
ABOUBAKRELNASHAR
5. 9/3/2022
Why there is a need for a more comprehensive & updated
classification?
I. Limitations Of Existing Classification
1. Anovulation is only one extreme of ovulatory dysfunction
that includes a spectrum of manifestations that range from
isolated episodes to chronic ovulatory failure.
2. Hormone levels do not obey clear rules. E. g.
hypothalamic amenorrhea who are underweight, LH levels
are usually suppressed, while FSH levels are often in the
normal range.13,14
3. Women with PCOS often have levels of FSH & LH in the
normal range.15 ABOUBAKRELNASHAR
II. Significant advances in
Understanding the control of ovulation & the
pathophysiology of ovulatory disorders
Assay technology & genomics.
ABOUBAKRELNASHAR
FIGO classification now includes 4 groups
Type I: Hypothalamic
Type II: Pituitary;
Type III: Ovarian
Type IV: PCOS
Acronym “HyPO-P,”where the “P” is separated from the other
three categories recognizing that it does not reside in a single
anatomic location.
provides practical utility and a second layer, or sub-
classification, for each of the three anatomically defined
entities, including discrete pathophysiological categories. These
can be remembered using the acronym “GAIN-FIT-PIE”
ABOUBAKRELNASHAR
After the individual is
diagnosed with an
ovulatory disorder,
1st level: allocation to type
I, II, or III disorders
according to their
presumed primary source:
hypothalamus, pituitary
gland, or ovary,
respectively. PCOS
comprises the type IV
category
2nd level stratifies each
anatomic category (types
I–III) into the known or
presumed mechanism
acc to the “GAIN-FIT-
PIE” mnemonic ABOUBAKRELNASHAR
2. CLINICAL APPLICATION
I. Identifying individuals with ovulatory disorders
Ovulatory disorders:
Any alteration of ovulatory function in women in the
reproductive years
Not synonymous with the term “anovulation.”
Exist on a spectrum ranging from episodic to ch
Typically, but not always: abnormalities in
menstrual parameters: frequency, regularity,
duration, volume, and, in the case of chronic
anovulation with amenorrhea
ABOUBAKRELNASHAR
Exist on a spectrum that ranges from occasional failure to
ovulate to chronic anovulation.
LUF and luteal out of phase (LOOP) disorders exist on a similar
spectrum of varying frequency.
ABOUBAKRELNASHAR
6. 9/3/2022
II. Further evaluations
Necessary to identify cause
Vary according to the clinical circumstance.
1. Ovulation predictor kits
LH surge in urine generally accurately reflect levels of
serum LH
Valuable tool for detecting ovulation in a given cycle.40
2. Measuring progesterone in the predicted luteal phase
may provide satisfactory evidence supporting ovulatory
function, particularly when 1st day of the next menstrual
period is known.41
ABOUBAKRELNASHAR
III. Categorization
Investigations to localize the site and the mechanism
contributing to ovulatory dysfunction. For example
Infrequent & irregular menses, galactorrhea,
elevated prolactin, and MRI demonstrating a
pituitary tumor would categorize as a type 2 –N
(pituitary neoplasm)
Irregular and infrequent menstruation, mild hirsutism, and
US ovarian volume: ≥10 ml or an ovary with ≥20 follicles
without a dominant follicle or corpus luteum, a circumstance
that dictates a type 4 –PCOS classification. Use of the 20-follicle threshold is
utilized only when the patient is examined with an endovaginal ultrasound transducer with a high frequency bandwidth of at least 8
ABOUBAKRELNASHAR