Freeze-all policy: systematic review and meta-analysisMatheus Roque
This study was presented during ASRM2018. This is a systematic review and meta-analysis evaluating the potential clinical, obstetrical and perinatal benefits of the freeze-all policy ver the fresh embryo transfer
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
Traditional embryo evaluation systems are simple, non-invasive, cost-effective & mainstay in majority of IVF laboratories. Embryo selection based on combinations of morphology scores at different stages of embryonic development with time may be more effective
Freeze-all policy: systematic review and meta-analysisMatheus Roque
This study was presented during ASRM2018. This is a systematic review and meta-analysis evaluating the potential clinical, obstetrical and perinatal benefits of the freeze-all policy ver the fresh embryo transfer
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
Traditional embryo evaluation systems are simple, non-invasive, cost-effective & mainstay in majority of IVF laboratories. Embryo selection based on combinations of morphology scores at different stages of embryonic development with time may be more effective
We are Leading IVF Clinic India offer IVF treatments with state of art facility and High Success rate. We are pioneering the field of Fertility Managment
It was while performing SUZI that a single spermatozoon accidentally penetrated into the oolemma and provided the hint that a direct sperm injection would be more efficient.
1st successful birth by ICSI took place on Jan 14, 1992.
Endometrial Receptivity Array- Dr Kaberi BanerjeeKaberi Banerjee
The endometrial receptivity array (ERA) is a diagnostic tool used in assisted reproductive technology (ART) to assess the receptivity of the endometrium, or the lining of the uterus, during the implantation window. While ERA has shown promise in improving the chances of successful embryo implantation, it also comes with its own set of advantages and disadvantages.
Pros of Endometrial Receptivity Array (ERA):
Personalized Timing: ERA helps determine the optimal window of endometrial receptivity for a specific woman. This personalized approach aims to synchronize the embryo transfer with the most favorable conditions for implantation, potentially improving the chances of successful pregnancy.
Reduced Pregnancy Loss: By accurately identifying the receptive window, ERA may contribute to reducing the risk of implantation failure and early pregnancy loss, especially in cases where previous IVF cycles were unsuccessful.
Improved Treatment Precision: ERA provides a more precise understanding of the individual's endometrial cycle, allowing fertility specialists to tailor the timing of embryo transfer to maximize the likelihood of success. This personalized approach may be particularly beneficial for women with irregular menstrual cycles.
Enhanced Cost-Efficiency: While the initial cost of an ERA test is an additional expense in the IVF process, the potential for increased success rates and reduced need for repeated embryo transfers may lead to cost savings in the long run.
Cons of Endometrial Receptivity Array (ERA):
Limited Evidence: Some critics argue that there is limited conclusive evidence supporting the routine use of ERA in all IVF cycles. The effectiveness of ERA is still a topic of ongoing research, and its widespread adoption may require more comprehensive validation.
Additional Cost: The ERA test adds an extra cost to the already expensive IVF process. Some couples may find it financially burdensome, especially if insurance coverage does not include this diagnostic procedure.
Invasive Nature: The endometrial biopsy required for the ERA test is an invasive procedure that may cause discomfort and pose a slight risk of infection or bleeding. However, the risks are generally minimal.
Time Consumption: The time required for the ERA test may extend the overall duration of the IVF process, which can be a concern for couples seeking a more expedited fertility treatment.
In conclusion, while the endometrial receptivity array offers potential benefits in improving IVF success rates through personalized timing, its adoption should be carefully considered based on individual circumstances, including financial considerations and the need for further research on its long-term efficacy.
We are Leading IVF Clinic India offer IVF treatments with state of art facility and High Success rate. We are pioneering the field of Fertility Managment
It was while performing SUZI that a single spermatozoon accidentally penetrated into the oolemma and provided the hint that a direct sperm injection would be more efficient.
1st successful birth by ICSI took place on Jan 14, 1992.
Endometrial Receptivity Array- Dr Kaberi BanerjeeKaberi Banerjee
The endometrial receptivity array (ERA) is a diagnostic tool used in assisted reproductive technology (ART) to assess the receptivity of the endometrium, or the lining of the uterus, during the implantation window. While ERA has shown promise in improving the chances of successful embryo implantation, it also comes with its own set of advantages and disadvantages.
Pros of Endometrial Receptivity Array (ERA):
Personalized Timing: ERA helps determine the optimal window of endometrial receptivity for a specific woman. This personalized approach aims to synchronize the embryo transfer with the most favorable conditions for implantation, potentially improving the chances of successful pregnancy.
Reduced Pregnancy Loss: By accurately identifying the receptive window, ERA may contribute to reducing the risk of implantation failure and early pregnancy loss, especially in cases where previous IVF cycles were unsuccessful.
Improved Treatment Precision: ERA provides a more precise understanding of the individual's endometrial cycle, allowing fertility specialists to tailor the timing of embryo transfer to maximize the likelihood of success. This personalized approach may be particularly beneficial for women with irregular menstrual cycles.
Enhanced Cost-Efficiency: While the initial cost of an ERA test is an additional expense in the IVF process, the potential for increased success rates and reduced need for repeated embryo transfers may lead to cost savings in the long run.
Cons of Endometrial Receptivity Array (ERA):
Limited Evidence: Some critics argue that there is limited conclusive evidence supporting the routine use of ERA in all IVF cycles. The effectiveness of ERA is still a topic of ongoing research, and its widespread adoption may require more comprehensive validation.
Additional Cost: The ERA test adds an extra cost to the already expensive IVF process. Some couples may find it financially burdensome, especially if insurance coverage does not include this diagnostic procedure.
Invasive Nature: The endometrial biopsy required for the ERA test is an invasive procedure that may cause discomfort and pose a slight risk of infection or bleeding. However, the risks are generally minimal.
Time Consumption: The time required for the ERA test may extend the overall duration of the IVF process, which can be a concern for couples seeking a more expedited fertility treatment.
In conclusion, while the endometrial receptivity array offers potential benefits in improving IVF success rates through personalized timing, its adoption should be carefully considered based on individual circumstances, including financial considerations and the need for further research on its long-term efficacy.
Understanding the Frozen Embryo Transfer Procedure: A Comprehensive GuideSCI IVF Hospital
The prospective mother’s ovaries are artificially stimulated in new IVF rounds to generate a larger number of mature eggs. The eggs are then extracted via a process known as a follicular puncture or ovum pick-up (OPU) and then fertilized in the lab using the husband’s or donor sperm. Here is a list of frozen embryo transfer tips to improve your success rate of embryo transfer.
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
1. ENDOMETRIAL RECEPTIVITY ANAYSIS
“ YTP UPDATE 2020”
Author - Dr Kalyani Shrimali
Fertility Consultant
,Nova IVF, IndoreDr. Neharika M Bora
MD(obgyn), DRM Germany
Rainbow IVF, Agra
BROUGHT TO YOU BY
YTP CHAIRPERSON
Human implantation is a complex process requiring synchrony between a healthy embryo and a functionally
competentorreceptiveendometrium
The bottleneck for IVF ICSI program is Implantation. Because in an ivf/icsi cycle we have made sure that the
fertilization takes place (unlike in an IUI or in a natural attempt at home) and have used the assistance of USG to
monitortheright timeforembryotransferaccordingtotheendometrialpattern.
Endometrial Receptivity (ER) is an important parameter for successful implantation, especially in IVF treatment
where,ineachcycle,embryotransferistobeperformedataspecifictime.
Advent of “Omics” that is, the analysis of biological samples using molecular profiling has revived interest in the
study of Endometrial Receptivity particularly in the context of implantation failure (IF) in IVF.After many years of
research , decoding endometrial transcriptomics using next-generation sequencing(NGS) and thus indentifying
1
thepersonalisedwindowofimplantation(pWOI)isnowpossible )
Introduction :
The endometrium is receptive when it is ready for embryo implantation to
occur. This period of receptivity is called the window of
implantation(WOI). The WOI is defined as the window of opportunity
during whichtheendometrium becomesmaximumreceptivetoembryo.
Each woman has a unique window. For some women the window is
shorter and/or displaced. By knowing your personal window of
implantation, you can optimise your chances of pregnancy through a
personalisedembryotransfer.
What is Endometrial Receptivity ?
ERAis acustomized test to analyse238 genes expressedat various
stages of the endometrial cycle in a given sample. It evaluates
endometrial receptivity to determine the optimal time for embryo
transferandwhemtheendometrium isreadyforimplantation.
By investigating the gene expression profile we can evaluate the
endometrial receptivity or understand the window of implantation
which is the clinical parameter for reproductive health. It evaluates
238 genes involved in endometrial receptivityand can tell us when
theendometrium isreadyforimplantation.
What is Endometrial Receptivity ?
2. · ReccurentImplantationfailurepatients:
- 2ormoreimplantationfailureswithownembryosor1withovumdonation
- Goodeuploidembryos
· Patientswithmorphologicallynormalendometrium :
- ERAafterinterventioninthecaseofancongenitaluterine anomalies
· Patientswithnormal,atrophicorhypertrophicendometrium
- Incaseofatrophicorhypertrophic,ithastobeconsistentforallthecyclesinthepatient.
Who needs it or indications?
The test could be done in natural , modified natural cycle or hormone replacement therapy (HRT) protocol,
accordingtotheprotocoltobeusedattimeoffrozenembryotransfer.
It just needs a standardized endometrial biopsy once the endometrium is prepared through the described
protocols.
ERA PROCEDURE – Preparation and Biopsy
EB innaturalcycle doneatLuteinisinghormone(LH)+7
- LHsurgecanbedetectedinurineorbloodoncethefollicleis15mmonUSG
- ThedayofLHsurgeisLH+0andthesampletaken7days(168hours)afterthat(LH+7)
ModifiedNaturalcycle (Naturalcycle withhcg-hcg+7)
- hCGwillberoutinelyadministeredoncethefolliclesizeis17mmormore
- ThedayofhCGishCG+0,EBwilltakenonhCG+7
HRT protocol(P+5)
- Themostpreferredmethodduetoitseasyexecutionandlessercancellations.
- Tablet estradiol valerate 6-8 mg is started from day2/3 of menses and continue till the TVS scan reveals
thedesiredendometrialthickness(6mmormoretrilaminarpattern),normallyitsaround10days.
- Once the endometrium is ready send the progesterone test to rule out any ovulation and start the
progesterone in same dose and formulation as it will be at time of embryo transfer and to do the EB post
5daysofprogesteroneincaseofblastocysttransferorat120hours
Natural Cycle :
Fig 1 : Personalised embryo transfer recommendation based on endometrial receptivity ananlysis (ERA) results
1
inHRTprotocol
PleasenoteERAtestcannotbedoneinastimulatedcycle.
3. ?Keepinfridge(4–8c)for4hrs.
?Thispreservedsample,incryotubecanbeimmediatelyshippedatroomtemp.
?Sampleatroomtempshouldreachthemainlabwithin 4to5days.
?Resultswillbereadyin20daysafterreceivingsamples.
STORAGE
• Receptive – Suggests that the gene expression profile is similar to that of a normal receptive endometrium.
TheETwillbeperformedunderthesameconditionsandtiming inwhichthebiopsywastaken
• Non-Receptive – Suggests that the gene expression profile is not similar to that of a endometrium of
receptivephase.
Pre-Receptive-Theendometrium hasnotyetreachedtheoptimalstageofreceptivity
Post-Receptive-Theoptimalstageofreceptivityhaspassed
With the above results a recommendation is also given for the timing of WOI for the personalized embryo
transfer (pET). In some cases, to validate this pWOI , a second biopsy maybe recommended as per the time
recommendationgiven.
A receptive result indicates the ideal day of blastocyst transfer . If the embryo is of day3 , it should be
transferred2daysearlierthantherecommendedERAresult.
Thisishowtheresultswouldlooklike
Interpretation of results
Non-receptive -Prereceptive result Non -receptive- Post-receptive
ERA test is very sensitive in indentifying the genetic expressions of the endometrium to tell us the exact embryo
transfer time. pET or personalised embryo transfer can help to increase the success rates (PR and IR)
significantly. It is of vital help especially in cases of recurrent implantation failures where we are clueless about
thereasonbehindthenegativeivfresult.
Conclusion :
1. Igenomix(2009).ERAEndometrialReceptivityAnalysis(Online)Availablefromhttp://www.igenomix.com
2. Diaz -GimenoP,Horcadjadas JA , Martinez-ConejaroJA,et al. A genomic diagnostic tool for human
endometrialreceptivitybasedontranscriptomicsignature.FertilSteril2011;95:50-60
Compared to other methods, the accuracy of ERA test is much better (sensitivity of 0.997 and a specificity
2
of0.885)
References
