Is it the seed or the soil? Arthur Leader, MD, FRCSC
|
|
- Gwendoline Owens
- 6 years ago
- Views:
Transcription
1 The Physiological Limits of Ovarian Stimulation Is it the seed or the soil? Arthur Leader, MD, FRCSC
2 Objectives 1. To consider how ovarian stimulation protocols work in IVF 2. To review the key events in follicular development in IVF 3. To review the impact of controlled ovarian hyperstimulation protocols for poor responders on the oocyte and endometrium
3 Pregnancy requires: Implantation of a developmentally competent embryo into a receptive endometrium
4 1980 s hmg Clomiphene Stimulation protocols in IVF hcg or LH surge OPU ET (1,2) 1990 s hmg/ufsh Agonist LH E 2 USS Daily s.c./i.n. dose hcg M E 2 USS LH OPU ET(2) ET(3)
5 2000 s rfsh Antagonist Vag P4 Stimulation protocols in IVF IU hcg 250 mcg E 2 /USS OPU ET(3) ET(5) 2010 s SR-FSH Antagonist rfsh Vag P4 hcg 250 mcg IU E 2 /USS OPU ET(3) ET(5)
6 Wave theory of follicle development
7 Growth of follicles and attrition in vitro Levéillé, M-C, Ottawa Fertility Centre
8 Levéillé, M-C, Ottawa Fertility Centre
9 Attrition from COC to good blastocyst Ottawa Fertility Centre, unpublished data, 2010
10 Attrition at each Step % reaching the stage of a good morphology blastocyst COC 19% MII 22% 2PN 29% Good D3 embryo 38% Good D4 embryo 60% Good D3 embryo: at least 5-cell, at least grade 3, not blocked, no multinucleation Good D4 embryo: at least compacting, at least grade 3, not blocked, no multinucleation Ottawa Fertility Centre, unpublished data, 2010
11 IVF outcome in relation to number of Fertilization rates oocytes collected 1-3 eggs 4 6 eggs 7-10 eggs eggs > 15 eggs 56% 54% 55% 57% 54% Chance of ET 71.3% a 91.3% a 95.3% a 97.2% a 96.9% a Blastocyst ET 0.5%* 3.4%* 13.8%* 30.2%* 41.6%* Pregnancy rates 13.3 a 24.6% a 33.4% a 38.2% a 41.9% a No significant increase clinical pregnancy rates if more than six eggs collected Data for 4701 treatment cycles Hamoda, Sunkara, Khalaf, Braude and El-Toukhy, O-120, ESHRE 2010
12 What is the optimal protocol for IVF therapy? Hinges on probability of live birth Current estimates of live birth probabilities: based mainly on age, adjusted for other factors using semiquantitative scoring systems
13 Deep phenotyping to predict live birth outcome in IVF Boosted tree analysis stratifies patients according to clinical profiles Deep phenotyping : sorts patients into subsets defined by similar clinical characteristics uses data known prior to and during 1 st IVF cycle generates model to predict live birth probabilities in next cycle 1000 times more accurate than age-based approach PNAS (31)
14 Highly significant predictors of a live birth in an IVF cycle (p<0.001) Positive predictors PCOS* Endometrial thickness Total # of oocytes % normal fertilization Total # embryos Ave # cells/ embryo % 8-cell embryos % embryos that are blasts % embryos that were frozen Ave # cells/transferred embryo Day 5 embryo transfer Negative predictors Age of patients* Diminished ovarian reserve* Total units of gonadotropins # arrested embryos at 4 cells Assisted hatching Deep phenotyping to predict live birth outcomes in IVF, Banerjee et al., PNAS, 2010
15 Prognostic factors and their relative influence in an IVF model PNAS (31)
16 Increased gonadotropin dose and IVF outcomes Fertility and Sterility 2008; 89:
17 What about the poor responder? Expected Advanced maternal age Previous ovarian cystectomies (endometriosis) Documented low ovarian reserve Smoker Unexpected No internationally agreed upon definition: Poor follicular recruitment High dose of gonadotropins Low peak serum estradiol levels
18 Stimulation options for the poor responder in IVF Microdose flare protocol Estradiol- antagonist protocol Natural cycle
19 Optimal maximal dose: microdose flare protocol
20 Viable Pregnancy (IUP FH)/OPU 2009 % < >42 Up to 300 IU FSH/day More than 300 IU FSH/day
21
22 Microdose flare vs. Estradiol/Antagonist for IVF in Young Poor Responders Patch protocol More IU s of gonadotropin Lower estradiol Better embryo quality
23
24 Growth hormone for poor responders in IVF Kolibiankis et al, Hum Reprod 2009
25 Day 2 vs. Day 3 Embryo Transfer in Poor Responders
26 Natural cycle IVF
27 Drop-out rates and natural cycle
28 Miscarriage rates Haadsma et al: RBM Online, 20 (2), , 2010
29 Follicular Development We believe that achieving optimal conditions in the follicle at the time of oocyte recovery is one of the essential features in the establishment of pregnancy. Fishel, Edwards and Purdy : Murnau Symposium, June 2, 1982 What are the optimal conditions?
30 Overexposure to LH overexposure to LH during follicular development may be detrimental to fertilisation in vitro LH may act by either altering the steroid environment of the follicle or by causing premature oocyte maturation. Howles, MacNamee, Edwards, Goswamy, Steptoe: Lancet, Aug. 30, 1986 Could overexposure to FSH be detrimental as well?
31 The Menstrual Cycle Dighe et al. Clin biochem: 38(2), 2005,
32
33 Ovarian biochemistry basics Ovaries with large number of growing follicles stimulated by high circulating FSH will secrete more progesterone than single follicle with declining FSH Prior to ovulation, LH reduces circulating progesterone by promoting conversion of androgens estrogens by granulosa cells Highly suppressive doses of GnRH agonists / antagonists increase dose requirements for FSH and profoundly suppress LH levels
34 FSH doses and the follicle High follicular FSH concentrations: Cause inappropriate cumulus cell differentiation Leading to poor egg developmental competence Possibly altered oocyte-cumulus cell gene expression
35 Experimental model
36 Effect of FSH doses on gene expression during in vitro antral follicle growth Three levels of FSH: control, decreasing, high At all levels: antral development, oocyte diameter and meiotic resumption were equal Progesterone production increased in the high-fsh group Normal decline in oocyte Bmp15 and Gdf9 prevented in high-fsh group Abnormal cumulus cell differentiation and functionality occurred in high-fsh group Sanchez, Adriaenssens, Romero, Smitz: Biol Reprod 83, , 2010
37 Implantation Most of the steps involved in establishing pregnancies by in vitro fertilization have largely been mastered.the major difficulty that remains concerns the proportion of embryos which implant, which is depressingly low Implantation rates for single embryo: 36.8% vs. 23.2% (natural vs. stimulated) [Table VIII] Edwards and Steptoe: Lancet 3 December, 1983 How do our stimulations affect implantation?
38 Stimulation and the endometrium All protocols affect endometrial receptivity when compared to the natural cycle GnRH antagonist protocols are more similar to natural cycle receptivity than agonist protocols Luteal support with progesterone +/- estrogen significantly alters expression of ECM protein and adhesion molecule genes
39 Percentage of genes in common: stimulated and natural cycles in the receptive endometrium Haouzi D et al. Biol Reprod 2010;82:
40 In Conclusion Predictive models may help us to better adjust protocols to the patient For the normal responder, lower gonadotropin dosing appears to be best For the poor responder we are caught between the need to get 6 eggs and the high doses required to get there Growth hormone may assist in our stimulations Our protocols and supplements impact not only the follicle but also the endometrium in ways we have yet to discover
Female Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF
Female Reproductive Physiology Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF REFERENCE Lew, R, Natural History of ovarian function including assessment of ovarian reserve
More informationA Tale of Three Hormones: hcg, Progesterone and AMH
A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Interpreting Follicular Phase Progesterone Ernesto Bosch IVI Valencia,
More informationBest practices of ASRM and ESHRE
Best practices of ASRM and ESHRE Late submission Cortina d Ampezzo, Italy 1-3 March 2012 A joint meeting between the American Society for Reproductive Medicine and the European Society of Human Reproduction
More informationInfluence ovarian stimulation on oocyte and embryo quality. Prof.Dr. Bart CJM Fauser
Influence ovarian stimulation on oocyte and embryo quality Prof.Dr. Bart CJM Fauser How to balance too much vs too little? Lecture Outline Context ovarian stimulation Impact ovarian stimulation on oocyte
More informationLuteal phase rescue after GnRHa triggering Progesterone and Estradiol
Luteal phase rescue after GnRHa triggering Progesterone and Estradiol L. Engmann University of Connecticut Disclaimer Fertility Speaker Bureau Merck Pharmaceuticals Introduction GnRH agonist is effective
More informationPoor & Hyper responders: what is the best approach?
Poor & Hyper responders: what is the best approach? A. La Marca ObGyn Dept University of Modena and Reggio Emilia Italy Center for Reproductive Medicine University Hospital of Modena Italy Criteria used
More informationMilder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization
Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization Revelli et al. Reproductive Biology and Endocrinology 2011, 9:25 Presenter: R2 孫怡虹 Background
More informationProgesterone and clinical outcomes
Synchronization of Slowly Developing Embryos Restores Implantation Success Richard T. Scott, Jr, MD, HCLD Clinical and Scientific Director, Reproductive Medicine Associates of New Jersey Professor and
More informationTreatment of Poor Responders
Treatment of Poor Responders Pathophysiology of Poor Responders Deficiency in systemic IGF 1 levels (Bahceci, 2007) Lower intra ovarian T levels Reduced FSH receptor expression (Cai, 2007) Bahceci, 2007,
More informationOvarian stimulation and inflammation, not always friends! Marc-André Sirard DVM PhD, Canadian Research Chair in Reproduction Genomics
Ovarian stimulation and inflammation, not always friends! Marc-André Sirard DVM PhD, Canadian Research Chair in Reproduction Genomics Conflict of interest Controlled Ovarian Stimulation Timing Test (COST2)GFI
More informationInterpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used
Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Ellenbogen A., M.D., Shalom-Paz E., M.D, Asalih N., M.D, Samara
More informationPrinciples of Ovarian Stimulation
Principles of Ovarian Stimulation Dr Genia Rozen Gynaecologist and Fertility Specialist Royal Women s Hospital and Melbourne IVF Learning objectives Why ovarian stimulation Recap physiology Ovarian cycle
More informationFemale Reproductive System. Lesson 10
Female Reproductive System Lesson 10 Learning Goals 1. What are the five hormones involved in the female reproductive system? 2. Understand the four phases of the menstrual cycle. Human Reproductive System
More informationLOW RESPONDERS. Poor Ovarian Response, Por
LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients
More informationRaoul Orvieto. The Chaim Sheba Medical Center Tel Hashomer, Israel. Declared no potential conflict of interest
Raoul Orvieto The Chaim Sheba Medical Center Tel Hashomer, Israel Declared no potential conflict of interest LH in antagonist cycles; is the story really written? Raoul Orvieto M.D. Israel Overview Role
More informationThe emergence of Personalized Medicine protocols for IVF.
Individualising IVF: Introduction to the POSEIDON Concept Introduction The emergence of Personalized Medicine protocols for IVF. Differences between patients: age, ovarian reserve, BMI or presence of ovarian
More informationIVF Protocols: Hyper & Hypo-Responders, Implantation
IVF Protocols: Hyper & Hypo-Responders, Implantation Midwest Reproductive Symposium June 4-5, 4 2010 Subset : Hyper-Responders Mark R. Bush, MD, FACOG, FACS OBJECTIVE: Important goals for the PCOS patient
More informationLUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi
LUTEAL PHASE SUPPORT Doç. Dr. Nafiye Yılmaz Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi TAJEV, 2014 1 ART & success *Live birth rate 2 Optimal luteal phase Etiology of luteal phase deficiency
More informationEndometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY
Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY Natural Cycle FET Protocol for endometrial preparation N FET, including modified N FET HRT FET:
More informationA Tale of Three Hormones: hcg, Progesterone and AMH
A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Human Ovarian Steroidogenesis and Gonadotrophin Stimulation Johan
More informationRelevance of LH activity supplementation
Relevance of LH activity supplementation in ovulation induction Franco Lisi Servizio di Fisiopatologia della Riproduzione Clinica Villa Europa Roma, Italia Comprehension of the role of LH in follicular
More information10.7 The Reproductive Hormones
10.7 The Reproductive Hormones December 10, 2013. Website survey?? QUESTION: Who is more complicated: men or women? The Female Reproductive System ovaries: produce gametes (eggs) produce estrogen (steroid
More informationScientific Highlights: First world conference on luteinizing hormone in ART: Landing in Asia Pacific
This EXCEMED conference followed on from the First world conference on luteinizing hormone (LH) in ART, which took place in Naples in May 2016. Bringing the topic of LH to Asia Pacific provided an opportunity
More informationL6: DuoStim: the alternative of oocytes/embryos accumulation programs Carlo Alviggi
L6: DuoStim: the alternative of oocytes/embryos accumulation programs Carlo Alviggi Italy What is the aim of IVF? What is the measure of success in IVF? Cumulative live birth rate per started cycle Live
More informationThe Human Menstrual Cycle
The Human Menstrual Cycle Name: The female human s menstrual cycle is broken into two phases: the Follicular Phase and the Luteal Phase. These two phases are separated by an event called ovulation. (1)
More informationlbt lab tests t Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour
lbt lab tests t and Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour Research Instituteof Avicenna 4/23/2012 Why good prediction of poor response good prediction i of OHSS application appropriate
More information1. During the follicular phase of the ovarian cycle, the hypothalamus releases GnRH.
1. During the follicular phase of the ovarian cycle, the hypothalamus releases GnRH. 2. This causes the anterior pituitary to secrete small quantities of FSH and LH. 3. At this time, the follicles in the
More informationIvf day 6 estradiol level
Ivf day 6 estradiol level Search It is also important to measure the estradiol on day 3. Day 2 is fine. The reason its day 3 is 15-20 years ago, the IVF medications were always started on day 3. Day 3
More informationInfertility Clinical Guideline
Infertility Clinical Guideline Ovarian Stimulation Guideline Purpose: To provide sufficient background regarding various ovarian stimulation protocols for In Vitro Fertilization cycles. Goal: To assist
More informationDr. Ernesto Bosch Instituto Valenciano de Infertilidad Valencia, Spain. Declared no potential conflict of interest
Dr. Ernesto Bosch Instituto Valenciano de Infertilidad Valencia, Spain Declared no potential conflict of interest Is there a role for LH in elderly patients? Dr. Ernesto Bosch Instituto Valenciano de Infertilidad.
More information(BMI)=18.0~24.9 kg/m 2 ;
33 10 Vol.33 No.10 2013 10 Oct. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.10.0672 E-mail: randc_journal@163.com - ( 400013) : () GnRH-a - () : IVF- ET 233 A (I~II 102 ) B (III~IV
More information(1.,, ) (2.,,, )
33 11 Vol.33 No.11 2013 11 Nov. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.11.0749 E-mail: randc_journal@163.com IVF-ET 1 2 1 1 1 1 1 (1. 510150) (2. 510150) : (COH) (premature
More informationENDOCRINE CHARACTERISTICS OF ART CYCLES
ENDOCRINE CHARACTERISTICS OF ART CYCLES DOÇ. DR. SEBİHA ÖZDEMİR ÖZKAN KOCAELI UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, IVF UNIT 30.04.2014, ANTALYA INTRODUCTION The endocrine
More informationNeil Goodman, MD, FACE
Initial Workup of Infertile Couple: Female Neil Goodman, MD, FACE Professor of Medicine Voluntary Faculty University of Miami Miller School of Medicine Scope of Infertility in the United States Affects
More informationReproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands
Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty
More informationAgonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M
Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Record Status This is a critical abstract of an economic
More informationIVF (,, ) : (HP-hMG) - (IVF- ET) : GnRH, HP-hMG (HP-hMG )57, (rfsh )140, (Gn)
34 11 Vol.34 No.11 2014 11 Nov. 2014 Reproduction & Contraception doi: 10.7669/j.issn.0253-3X.2014.11.0892 E-mail: randc_journal@163.com IVF ( 710003) : (H-hMG) - (IVF- ET) : GnRH H-hMG (H-hMG ) (rfsh
More informationIVM in PCOS patients. Introduction (1) Introduction (2) Michael Grynberg René Frydman
IVM in PCOS patients Michael Grynberg René Frydman Department of Obstetrics and Gynecology A. Beclere Hospital, Clamart, France Maribor, Slovenia, 27-28 February 2009 Introduction (1) IVM could be a major
More information% Oocyte Donation Pregnancyes (days 3)
Ovulation induction in oocyte donors Roma- September 2007 Dr. José Remohí Dr. Carmen Rubio Dr. Amparo Mercader Dr. Pilar Alama Dr. Marco Melo Evolution of oocyte donation cycles 1500 1500 1000 58% 661
More informationEstradiol Level on Day 2 and Day of Trigger: A Potential Predictor of the IVF-ET Success
DOI 10.1007/s13224-014-0515-6 ORIGINAL ARTICLE Estradiol Level on Day 2 and Day of Trigger: A Potential Predictor of the IVF-ET Success Prasad Sudha Kumar Yogesh Singhal Megha Sharma Shashi Received: 27
More informationDo aromatase inhibitors have a place in IVF?
Do aromatase inhibitors have a place in IVF? Roy Homburg Maccabi Medical Services and Barzilai Medical Centre, Ashkelon, Israel Antalya, September, 2009 Human Follicle Growth Primordial follicle 1 layer
More informationThe intra-follicular molecular biology mandating advancement of egg retrieval in some women
The intra-follicular molecular biology mandating advancement of egg retrieval in some women David H. Barad, USA Director of Assisted Reproductive Technology, The Center for Human Reproduction New York
More informationInfertility treatment
In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation
More informationComparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization
Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization Peter Kovacs, M.D., a Timea Kovats, M.D., a Artur Bernard,
More informationStudy on Several Factors Involved in IVF-ET of Human Beings
Study on Several Factors Involved in IVF-ET of Human Beings Lei X 1, Zhuoran W 1, Bin L 1, Huiming L 1, Hongxiu Z 1, Yajuan Z 1, Yingbo Q 1, Guixue Z 2 1 The First Clinical College of Harbin Medical University,
More informationIntérêt de l hcg et induction de l ovulation. Christophe Blockeel, MD, PhD Centre for Reproductive Medicine, Brussels, Belgium
Intérêt de l hcg et induction de l ovulation Christophe Blockeel, MD, PhD Centre for Reproductive Medicine, Brussels, Belgium Conflict of interest The opinions expressed in this document are the opinions
More informationMenstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
Human Reproduction Vol.21, No.4 pp. 1012 1017, 2006 Advance Access publication December 8, 2005. doi:10.1093/humrep/dei415 Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
More informationFertility assessment and assisted conception
Fertility assessment and assisted conception Dr Geetha Venkat MD FRCOG Director Pulse Learning Women s health 14 September 2016 Disclosure statement Dr Venkat is a director of Harley Street Fertility Clinic.
More informationMinimising IVF related mortality and morbidity. Scott Nelson Muirhead Professor in Obstetrics & Gynaecology
Minimising IVF related mortality and morbidity Scott Nelson Muirhead Professor in Obstetrics & Gynaecology We rarely say no - so what I will cover today VTE as an example of a modifiable IVF complication
More informationNumber of oocytes and live births in IVF
Number of oocytes and live births in IVF Dr Sesh K Sunkara MD, MRCOG Royal Marsden Hospital, London Kings Healthcare Partners (Guy s & St Thomas NHS Foundation Trust), London, UK Background IVF results
More informationModified natural cycles: the Italian experience
CLINICA VALLE GIULIA, Rome Modified natural cycles: the Italian experience Filippo Maria Ubaldi M.D. M.Sc. Poor ovarian Response ESHRE Campus symposium Bologna 19-20 March 2010 Introduction Ovarian superovulation
More informationIn Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome
Original Article Effect of Laparoscopic Ovarian Drilling on Outcomes of In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome Maryam Eftekhar, M.D. 1, Razieh Deghani Firoozabadi,
More informationManish Banker. Declared receipt of grants; member of a company advisory board, board of director or similar group
Manish Banker Nova IVI Fertility Pulse Women's Hospital Gujarat, India Declared receipt of grants; member of a company advisory board, board of director or similar group The Indian point of view Manish
More informationHCG mode of action versus GnRHa action for triggering of final oocyte maturation
HCG mode of action versus GnRHa action for triggering of final oocyte maturation Nick Macklon Professor of Obstetrics and Gynaecology, University of Southampton A hammer to crack a nut hcg? How hard does
More informationOriginal Article Impact of estrogen-to-oocyte ratio on live birth rate in women undergoing in vitro fertilization and embryo transfer
Int J Clin Exp Med 2015;8(7):11327-11331 www.ijcem.com /ISSN:1940-5901/IJCEM0008838 Original Article Impact of estrogen-to-oocyte ratio on live birth rate in women undergoing in vitro fertilization and
More informationUse of in vitro maturation for fertility preservation
Use of in vitro maturation for fertility preservation G. Arroyo Servei de Medicina de la Reproducció Departament d Obstetrícia, Ginecologia i Reproducció INSTITUT UNIVERSITARI DEXEUS MEDICAL STRATEGY TO
More informationHonorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive FIGO s Distinguished Merit Award for Services towards women s health.
Prof.Duru Shah Founder President The PCOS Society (India) President Elect of the Indian Society for Assisted Reproduction (ISAR) Honorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive
More informationSredišnja medicinska knjižnica
Središnja medicinska knjižnica Kasum M., Kurdija K., Orešković S., Čehić E., Pavičić-Baldani D., Škrgatić L. (2016) Combined ovulation triggering with GnRH agonist and hcg in IVF patients. Gynecological
More informationThe reproductive lifespan
The reproductive lifespan Reproductive potential Ovarian cycles Pregnancy Lactation Male Female Puberty Menopause Age Menstruation is an external indicator of ovarian events controlled by the hypothalamicpituitary
More informationLH activity administration during the
LH activity administration during the luteal-follicular transition Richard Fleming On behalf of the Luveris Pre-treatment group University of Glasgow Scotland Androgens have a Paracrine action in the Early
More informationChapter 27 The Reproductive System. MDufilho
Chapter 27 The Reproductive System 1 Figure 27.19 Events of oogenesis. Before birth Meiotic events 2n Oogonium (stem cell) Mitosis Follicle development in ovary Follicle cells Oocyte 2n Primary oocyte
More informationPrognosticating ovarian reserve by the new ovarian response prediction index
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Tak A et al. Int J Reprod Contracept Obstet Gynecol. 2018 Mar;7(3):1196-1200 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180917
More informationIndividualized treatment based on ovarian reserve markers
Individualized treatment based on ovarian reserve markers Prof Dr. Nikolaos P. Polyzos M.D. PhD Professor and Medical Co- Director, Vrije Universiteit Brussel, UZ Brussel, Belgium Professor of Reproduc?ve
More information9.4 Regulating the Reproductive System
9.4 Regulating the Reproductive System The Reproductive System to unite a single reproductive cell from a female with a single reproductive cell from a male Both male and female reproductive systems include
More informationCONTROLLED OVARIAN HYPERSTIMULATION AND OOCYTE RETRIEVAL : CLINICAL INPUTS. DR Priyanka Sinha MD OB-GYN MUMBAI, INDIA
CONTROLLED OVARIAN HYPERSTIMULATION AND OOCYTE RETRIEVAL : CLINICAL INPUTS DR Priyanka Sinha MD OB-GYN MUMBAI, INDIA LEARNING OBJECTIVE Introduction Ovarian stimulation protocols Comparison of different
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More informationINDICATIONS OF IVF/ICSI
PROCESS OF IVF/ICSI INDICATIONS OF IVF/ICSI IVF is most clearly indicated when infertility results from one or more causes having no other effective treatment; Tubal disease. In women with blocked fallopian
More informationA prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF
FVV IN OBGYN, 2012, 4 (2): 82-87 Original paper A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF S. GORDTS,
More informationArticle Luteal hormonal profile of oocyte donors stimulated with a GnRH antagonist compared with natural cycles
RBMOnline - Vol 13. No 3. 2006 326 330 Reproductive BioMedicine Online; www.rbmonline.com/article/1911 on web 13 June 2006 Article Luteal hormonal profile of oocyte donors stimulated with a GnRH antagonist
More informationBumiputera Sarawak Bumiputera Sabah. Others Foreigner. Had previous natural pregnancy Previous IVF pregnancies. IVF live births.
a. Date of notification: b. Name of reporting site: c.name of doctor in charge: AI : FEMALE PATIENT DETAILS & DEMOGRAPHICS (Instruction: if Mykad is not available, please complete Old IC or other ID document
More informationConcept : effects by treatment
QuickTime and a TIFF (LZW) decompressor are needed to see this picture. ESHRE CAMPUS 2010 MARIBOR INFLUENCE of stimulation on oocyte quality? Johan Smitz, MD, PhD UZBrussel Vrije Universiteit Brussel Brussels,
More informationREPRODUCCIÓN. La idea fija. Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings
REPRODUCCIÓN La idea fija How male and female reproductive systems differentiate The reproductive organs and how they work How gametes are produced and fertilized Pregnancy, stages of development, birth
More informationUniversal Embryo Cryopreservation: Frozen versus Fresh Transfer. Zaher Merhi, M.D.
Universal Embryo Cryopreservation: Frozen versus Fresh Transfer Zaher Merhi, M.D. Disclosure: None Fewer complications with IVF 1.5% children in US are born through ART 1.1 million children since 2006
More informationThe effect of adding oral oestradiol to progesterone as luteal phase support in ART cycles a randomized controlled study
Clinical research The effect of adding oral oestradiol to progesterone as luteal phase support in ART cycles a randomized controlled study Ashraf Moini 1,2, Shahrzad Zadeh Modarress 3, Elham Amirchaghmaghi
More informationReproductive Hormones
Reproductive Hormones Male gonads: testes produce male sex cells! sperm Female gonads: ovaries produce female sex cells! ovum The union of male and female sex cells during fertilization produces a zygote
More informationFertility in the 21 st Century Dr Leigh Searle
Fertility in the 21 st Century Dr Leigh Searle Fertility Specialist, Obstetrician, Gynaecologist FRANZCOG, PGDipOMG, MBChB Dr Kate Van Harselaar Fertility Specialist, Obstetrician and Gynaecologist Overview
More informationMODULE 1: OVULATION INDUCTION IN NORMAL RESPONDERS, POOR RESPONDERS, AND HYPERRESPONDERS
MODULE 1: OVULATION INDUCTION IN NORMAL RESPONDERS, POOR RESPONDERS, AND HYPERRESPONDERS Contents OVULATION INDUCTION IN NORMAL RESPONDERS, POOR RESPONDERS, AND HYPERRESPONDERS Ovulation Induction.....................................................................
More informationInfertility in Women over 35. Alison Jacoby, MD Dept. of Ob/Gyn UCSF
Infertility in Women over 35 Alison Jacoby, MD Dept. of Ob/Gyn UCSF Learning Objectives Review the effect of age on fertility Fertility counseling for the patient >35 - timing - lifestyle - workup Fertility
More informationPresident : Indian Society for Assisted Reproduction (ISAR) Past President FOGSI. Past Chairman ICOG. Founder Trustee Women s Empowerment Foundation
Founder President: The PCOS Society, India Honorary Fellow of the Royal College of Obst.& Gyn. Prof.Duru Shah President : Indian Society for Assisted Reproduction (ISAR) Past President FOGSI. Past Chairman
More informationInvestigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle?
Investigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle? Introduction: The menstrual cycle (changes within the uterus) is an approximately 28-day cycle that
More informationL2. Optimising IVF outcomes through increased number of oocytes... 03
SCIENTIFIC HIGHLIGHTS EXCEMED Blended Education Ovarian stimulation strategies: maximizing efficiency in ART Rio de Janeiro, Brazil 6-7 April 2018 Preface Success rates following IVF treatment have increased
More informationNatural Cycle & Mild stimulation IVF/ICSI in women with Poor Ovarian Response (POR)
Natural Cycle & Mild stimulation IVF/ICSI in women with Poor Ovarian Response (POR) Geeta Nargund Head of Reproductive Medicine St George s Hospital London ISMAAR Terminology Human Reprod Nargund et al
More informationThrombosis during assisted reproduction. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology
Thrombosis during assisted reproduction Scott Nelson Muirhead Chair in Obstetrics & Gynaecology ART can be as safe as natural pregnancy!! What used to be the risk of thrombosis in ART!! We can use AMH
More informationFixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol
Yamanashi Med. J. 14(3), 77 ~ 82, 1999 Original Article Fixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol Tsuyoshi KASAI and Kazuhiko
More informationHormonal Control of Human Reproduction
Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with
More informationI. ART PROCEDURES. A. In Vitro Fertilization (IVF)
DFW Fertility Associates ASSISTED REPRODUCTIVE TECHNOLOGY (ART) Welcome to DFW Fertility Associates/ Presbyterian-Harris Methodist Hospital ARTS program. This document provides an overview of treatment
More informationAssisted reproductive technology
Assisted reproductive technology FERTILITY AND STERILITY Vol. 60, No.2, August 1993 Copyright 'c; 199:~ The American Fertility Society Printed on acid-free paper in U. S. A. Natural cycle in vitro fertilization-embryo
More information2015 Mar.; 26(1):
Journal of Reproduction & Contraception doi: 10.7669/j.issn.1001-7844.2015.01.0022 2015 Mar.; 26(1):22-30 E-mail: randc_journal@163.com Clinical outcomes of using three gonadatropins and medroxyprogestrone
More informationInfertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary
Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that
More informationNGUYEN QUOC ANH. M.D., M.Sc. Tu Du Hospital Vietnam
NGUYEN QUOC ANH M.D., M.Sc. Tu Du Hospital Vietnam FULLY AUTOMATED AMH TESTING OF OVARIAN RESPONSE IN IVF NGUYỄN QUỐC ANH MD. Infertility dep. Tudu hospital Index What is AMH? Standard AMH testing Fully
More information2017 United HealthCare Services, Inc.
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 1143-4 Program Prior Authorization/Notification Medication Menopur (menotropins) * P&T Approval Date 8/2014, 5/2015, 5/2016, 5/2017
More informationHow to make the best use of the natural cycle for frozen-thawed embryo transfer?
How to make the best use of the natural cycle for frozen-thawed embryo transfer? Ariel Weissman, MD IVF Unit, Dep. Ob/Gyn Wolfson Medical Center, Holon Sackler Faculty of Medicine, Tel Aviv University
More informationOriginal Article Effects of a low hcg dose of 2000 IU on clinical outcomes of high-responder women undergoing IVF/ICSI
Int J Clin Exp Med 2016;9(7):14677-14683 www.ijcem.com /ISSN:1940-5901/IJCEM0026636 Original Article Effects of a low hcg dose of 2000 IU on clinical outcomes of high-responder women undergoing IVF/ICSI
More informationInternational Journal of Women s Health and Reproduction Sciences Vol. 6, No. 2, April 2018, ISSN
http://www.ijwhr.net Open Access doi 10.15296/ijwhr.2018.31 Original Article International Journal of Women s Health and Reproduction Sciences Vol. 6, No. 2, April 2018, 187 191 ISSN 2330-4456 Comparison
More informationClinical aspect of endometrial injury!
Clinical aspect of endometrial injury! Zeev Shoham, M.D. Department of Obstetrics and Gynecology Kaplan Hospital, Rehovot, Israel Implantation Process Good morphology embryo Normal uterus & receptive endometrium
More informationInfertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations
Infertility Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Beneficial effects of IUI not consistently documented in studies No deleterious effects on fertility 3-4 cycles of IUI should
More informationFactors influencing serum progesterone level on triggering day in stimulated in vitro fertilization cycles
ORIGINAL ARTICLE pissn 2233-8233 eissn 2233-8241 Clin Exp Reprod Med 2015;42(2):67-71 Factors influencing serum progesterone level on triggering day in stimulated in vitro fertilization cycles Ju Hee Park
More informationHold On To Your Dreams
Hold On To Your Dreams Dr. Michael Kettel Dr. Sandy Chuan 1. THE BASICS OF IVF & EMBRYO DEVELOPMENT 2. IVF ADD-ONS - MYTH VS. SCIENCE IN VITRO FERTILIZATION 1. Ovarian Stimulation 2. Egg Retrieval 3. Create
More informationSTIMULATION AND OVULATION TRIGGERING
STIMULATION AND OVULATION TRIGGERING Professor IOANNIS E. MESSINIS MD, PhD (Aberdeen, UK), FRCOG (UK) Department of Obs/Gynae University of Thessaly Larissa, GREECE DISCLOSURE Nothing to disclose Learning
More information