The document discusses advancements in reproductive medicine at Gana Hospital, focusing on the role of progesterone in brain protection during preterm labor and its potential for improving brain development in preterm infants. It highlights the evolution of next-generation DNA sequencing for genetic diagnosis and prenatal care, including non-invasive methods and preimplantation genetic diagnosis. Additionally, it presents new treatments and therapies in reproductive health, including novel uses of FSH and ulipristal acetate for fibroids.

1. What’s New???
Reproductive Medicine
Gana Hospital

2. Why!!!
• To be updated
• To modify
• To share

3. Progesterone

4. Brain
 Progesterone can be produced in the brain from
steroid precursors.
 they have been found to have neuroprotective function.

5. Progesterone for acute brain trauma

6. Progesterone & Preterm labor
Mainly for prevention of preterm labor
But still there are many preterm labor
Liable to cerebral palsy and delayed neural
development

7. Idea
Progesterone after preterm labor
For the preterm baby

8. Why
To protect the fetal brain
To improve brain development

9. Preterm fetus: Deprived from P4

10. Trottet et al, 2012
First case preterm baby having
progesterone therapy
Future

11. Genomic Sequencing
The coming Era

12. DNA sequencing
• Rapidly evolving
• Allow genetic diagnosis of diseases
• Allow prediction for disease later in life
• Determine human genome in details
Now Next generation Sequencer

13. Work flow of conventional versus second-
generation sequencing

14. 1. Prepare genomic DNA
2. Attach DNA to surface
3. Bridge amplification
4. Fragement become
double stranded
5. Denature the double
stranded molecules
6. Complete amplification
• Illumina
• ABI SOLiD
• Roche 454
• HeliScope
What is next-generation sequencing ?

15. 7. Determine first base
8. Image first base
9. Determine second base
10. Image second base
11. Sequence reads over
multiple cycles
12. Align data.
1 billion bases per
run, 1% of the cost
of capillary-based
method.

16. Preimplantation Genetic Diagnosis
(PGD)

17. Which Embryo is Disease-Free?

18. Non Invasive Prenatal Diagnosis
• Minimise the need for amniocenecis
• Cell free DNA (fetal in maternal blood)
• High accuracy

19. Towards Better Gene
Therapy

20. Spindle transfer !!!!!
• spindle-chromosomal complex transfer
• taking nuclear DNA from an egg cell and
transferring that DNA into another egg cell,
leaving the defective mitochondrial DNA
behind
• For genetic disease
• Safety?????? Gene therapy

21. Back to Simple Ideas

22. High dose FSH at hCG triggering
• Novel concept
• Give four ampoules of FSH at time of hCG
injection
• Why??????

23. LH surge is associated with FSH surge to a lesser extent

24. Outcome??
•10% increase in PR??

25. Corifolitropin alfa
• Long acting FSH
• Under the name of Elonva
• Single shot
• Contraindicated with PCOS
• Not self administered
• Not cheaper

26. Increasing LBR with Diagnostic
Hysteroscopy

27. Dienogest
• 19-nortestosterone
derivative
• Endometriosis
• Menorrhagia
• COC
• Pituitary suppression

28. DNG in endometriosis
• no glucocorticoid
• no antimineralocorticoid activity.
• no antiestrogenic activity
• due to DNG's low gonadotropic activity, E2
levels are not decreased to zero, in contrast to
treatments with gonadotropin-releasing
hormone (GnRH) analogues.

29. COC
• This maintenance beneficial E2 effects is
of particular importance for the general
tolerability of the first contraceptive pill
to use E2V instead of EE
• safer??

30. Ulipristal acetate & Fibroids
• oral selective progesterone receptor
modulator (SPRM) that has successfully
completed phase III clinical trials.
• licensed in Western Europe
• has shown efficacy with a significant reduction
in uterine bleeding, fibroid volume, and
improved quality of life
• low side effects unlike (GnRH) agonists.

31. Thank you
Professional Diploma
in Reproductive
Medicine