2014: What's new in Reproductive Medicine?
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Every day, there is something new that may or may not have an impact on our daily practice. In this talk , we want to highlight some of these new developments
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3) Progesterone should be started 24-48 hours after egg retrieval/release and continued until 9 weeks of pregnancy. The addition of a single GnRH agonist dose may further improve outcomes. hCG is not recommended due to risk of OHSS.
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3) Progesterone should be started 24-48 hours after egg retrieval/release and continued until 9 weeks of pregnancy. The addition of a single GnRH agonist dose may further improve outcomes. hCG is not recommended due to risk of OHSS.
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- Gonadotropins like hMG can cause multifollicular development and increase risks of complications like OHSS.
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Male infertility management
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4 - Molecular biology in medicine
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In vitro fertilization
This slide has been prepared for educational purpose using various standard medical books. This is prepared by medical student and if any mistakes are there please comment.
OHSS Management - Dr Dhorepatil Bharati
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This document discusses the use of progesterone to prevent preterm birth. It provides evidence from clinical trials that progesterone reduces the risk of preterm birth in women with a history of spontaneous preterm birth or a short cervix detected by ultrasound in the current pregnancy. The document recommends progesterone treatment between 16-20 weeks of gestation until 37 weeks for these high-risk groups based on Level I and III evidence. It finds insufficient evidence to recommend progesterone for low-risk groups without a prior preterm birth or short cervix.
Customers
The document discusses total cellular wellness and natural growth factor (NGF) supplements. It describes how NGF can regenerate nerve cells by stimulating them to return to the growth phase. The supplement contains bird nest extract and other natural ingredients like purple chokeberry and bacopa. It lists several benefits of NGF including stimulating nerve growth factors, helping with neurodegenerative diseases and memory enhancement, and regulating the immune system. The supplement may help healthy people, those with mild neurological conditions, and those with serious conditions. Global demand for nerve repair treatments is projected to reach $18.2 billion by 2024.
Customers
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Erythropoietin shows promise for reducing brain injury in neonatal hypoxic ischemic encephalopathy (HIE). Clinical trials show that high doses of erythropoietin given with therapeutic hypothermia may result in less MRI-detected brain injury and improved motor outcomes at 1 year for infants with HIE. A current phase III trial is evaluating whether high dose erythropoietin can reduce death or neurodevelopmental disability when given with hypothermia. Additional studies are still needed to determine the optimal dosing, timing, and duration of erythropoietin administration for HIE treatment, especially in low and middle-income countries.
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Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
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Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
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2014: What's new in Reproductive Medicine?
- 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.
- 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
- 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