Day 2 :
Keynote Forum
Yasser Zaghloul
Anesthesiology Institute – Sheikh Khalifa Medical City, UAE
Keynote: Does anesthesia have any effect on fertility?
Time : 09:45-10:30
Biography:
Dr. Yasser Zaghloul has completed his MBBCH, Ms. Sc, MD Ph.D., FCARCSI from Ireland he has been trained in anesthesia and critical care medicine in both Egypt and Ireland. He is the Consultant of Anesthesia; Sheikh Khalifa Medical City Abu Dhabi, UAE. He is the director of Abu Dhabi Anesthesia Club and Anesthesia Refresher Course he has extensive experience and interest in neuro-anesthesia & neurocritical care, neonatal & pediatric anesthesia, and perioperative medicine. He is a lecturer and instructor in the following international courses: FCCS, PFCCS, ENLS, Airway Management, Critical Care Nephrology, and mechanical ventilation courses. Previously he worked as a consultant of Anesthesia & ICU in Ireland and graduated in 1986 from Faculty of Medicine, Alexandria University Egypt.
Abstract:
World Health Organization (WHO) estimated that 234·2 million major surgical procedures are undertaken every year worldwide. All were done under general and/or regional anesthesia. About 59% of patients aged >15–59 years. On the other hand, management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro Fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. Evidence of serious toxicity in humans is not well established. The use of general anesthesia, especially nitrous oxide, for oocyte retrieval has an adverse effect on IVF outcome. This deleterious effect manifests itself only after embryo transfer and leads to lower pregnancy and delivery rates. Some anesthetic agents (propofol, thiopental, midazolam, fentanyl, and alfentanil) can accumulate in the follicular fluid. This can be used only as an indirect index of potential toxicity but cannot prove any real toxic effect on the outcome. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about General Anesthesia (GA) came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. Monitored Anesthesia Care (MAC) and loco-regional anesthesia appears safe alternative choices and there is evidence of improved outcome.
- Effectiveness of sexual counseling based: PLISSIT model on sexual function of women with Polycystic Ovarian Syndrome
Location: 17:15-17:30
Chair
Fahimeh Golbabaei
Iran University of Medical Sciences, Iran
Session Introduction
S M Rahman
Cradle Fertility Centre, India
Title: IVF & PCOS: Management and solutions
Time : 12:20-12:45
Biography:
S M Rahman has done his MBBS from R G Kar Medical College, Kolkata, India in 2001. He completed his MD in obstetrics and gynecology from prestigious AIIMS, New Delhi, India in 2006. He completed his senior residency from the same institute in 2009. At present, he is working a consultant in obs & gynae at CMRI hospital, Kolkata, India. He is also working as an IVF consultant at CRADLE fertility center at Kolkata, India. He is also the founder and medical director of CRADLE fertility center which is a high-quality IVF setup. He has publications in several national and international journals.
Abstract:
PCOS is a common polygenic multifactorial condition affecting a wide population. PCOS poses an interesting problem for assisted reproduction. Initial treatment of infertility in PCOS is ovulation induction with clomiphene citrate, letrozole, and low dose gonadotrophin. LOD has been suggested as an effective alternative to OI. Patients’ refractory to all these interventions or with existing pathology can undergo ART with a closely monitored setting to produce the desired outcome without much complication. Ovarian stimulation for women with PCOS often requires a different approach to that for women with normal ovaries. The response often is slow but then spiral rapidly to a picture of over response leading to OHSS and cyst formation. More oocytes are retrieved but fertilization rates were reduced when compared to another group of infertility patients. Despite comparable pregnancy rates, the miscarriage rate in PCOS following IVF remains high compared with women with normal ovaries. This the unwanted outcome is proportional to BMI, increased waist-hip ratio, and insulin resistance. OHSS is the most serious iatrogenic complication of IVF treatment. Patients with PCOS are at a higher risk of OHSS during IVF. The incidence is hard to quantify ranging from 10 to 18%. Pituitary desensitization with a GnRH agonist or antagonist has become a universal concept with ART. Risk of OHSS is more with agonist protocol in PCOS patients. The pros and cons of different gonadotrophin preparation have been debated for years. After the initial use of hMG and then highly purified FSH came the recombinant FSH, LH, and hCG. Overall, there appears to be little difference in outcomes when all studies are combined. Use of metformin as an adjunct within the context of IVF has been explored. Although there is variable data on improvement of take-home baby rate with metformin, it definitely reduces the incidence of OHSS. IVM has attracted a lot of attention as a new technique in patients with PCOS.
Ruhi Yasmin
Darbhanga Medical College and Hospital, India
Title: Polycystic Ovarian Syndrome and infertility
Time : 14:35-15:00
Biography:
Ruhi Yasmin has completed her MBBS from Shri Krishna Medical College and MS from Patna Medical College and Hospital, Bihar, India. She is the Director of Metro IVF Center, Darbhanga, India. She has published more than 14 papers in reputed journals and currently, she is working as a Teacher in Darbhanga Medical
College and Hospital, India.
Abstract:
Polycystic Ovarian Syndrome (PCOS) is the common endocrine disorder in women of a reproductive age, occurring in approximately one in seven women. Of these women approximately two-thirds will not ovulate on a regular basis and consequently may, therefore, seek treatment for ovulation induction. After exclusion of other significant causes of sub-fertility the pragmatic approach to ovulation induction is to commence with clomiphene citrate. The goal of ovulation induction is the development of a single ovulatory follicle and the avoidance of multiple gestations. Second line therapies consist of gonadotrophin therapy and laparoscopic ovarian drilling, the place of metformin therapy is believed to lie in the management of a woman with impaired glucose tolerance. It is imperative that all ovulation induction is performed with access to rapid serum estradiol monitoring and ultrasound facilities. The benefit of the use of aromatase inhibitors has not yet been proven in large studies. Women with PCOS undergoing in vitro fertilization (IVF) are at a substantial risk of ovarian hyperstimulation syndrome and this approach should be avoided if at all possible. If it is required these women may be suitable candidates for in vitro maturation of oocytes (IVM) so avoiding ovarian hyperstimulation. Women with PCOS are potentially at an increased risk of miscarriage and in pregnancy if they are at an increased risk of developing gestational diabetes, pregnancy-induced hypertension, and pre-eclampsia. Furthermore, the neonate has a significantly higher risk of admission to a neonatal intensive care unit and a higher perinatal mortality.
Hassan El Motawakel Ala Allah Hassan Soliman
Saudi German Hospitals, Saudi Arabia
Title: An initial study to evaluate the role of laparoscopic ovarian drilling in ovulatory women: Polycystic Ovarian Syndrome
Biography:
Hassan El Motawkel Ala Allah Hassan Soliman has done his M.B.B.Ch. At Ain Shams University, Cairo, Egypt. In 1983, and done his M.Sc (Obst. & Gyn.) in Ain Shams University, Cairo, Egypt in1989, Diploma of Obstetrics & Women Health, Dublin, Ireland. He worked as a consultant and head of the department of Ob&Gyn in different Egyptian Military Hospital from 2001 to 2007 in Egypt. He got the membership in Royal College of Obstetricians & Gynaecologists,(M.R.C.O.G.), London, UK in 2000. He got the Fellowship in Minimal Access Surgery. World Laparoscopic Hospital. Guryana, Haryana, India. Acting as a Consultant and Head of Department Ob .& Gyn. In Saudi German Hospitals from 2007 till now (2018) in K.S.A. He became the senior member of the European Society of Aesthetic Gynecology (E.S.A.G.) in 2015.
Abstract:
Introduction & Aim: Since its introduction in 1984, Laparoscopic Ovarian Drilling (LOD) has evolved into a safe and effective surgical treatment for ovulatory, infertile women with Polycystic Ovary Syndrome (PCOS), unresponsive to Clomiphene Citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates but without the risk of ovarian hyperstimulation syndrome and multiple pregnancies. It improves ovarian responsiveness to successive ovulation induction agents, its favorable reproductive and endocrinal effects are sustained long. The aim of this study was to evaluate the role of laparoscopic ovarian drilling in correcting an ovulation and failure of conception in women with Polycystic Ovarian Syndrome. The investigation was designed as a retrospective study, was undertaken at a tertiary referral unit in KSA, Saudi German Hospital, Asser. The participants comprised of 150 women between 20-30 years old and Body Mass Index (BMI) between 20-30, treated with Clomiphene Citrate but failed to ovulate or get pregnant.
Method: During the period from November 2015-July 2017, 150 patients of PCOS who underwent LOD were included in the diagnosis of PCO was based on Rotterdam criteria which to be present for diagnosis four punctures for 4 seconds at 40 Watts for each ovary using the diathermy needle, diameter per ovary were applied during laparoscopy as standard technique for LOD
and were followed up a patient for one year.
Result: A total of 150 patients with anovulatory infertility associated with PCOS who underwent LOD were included among the 150 patients, only 78 included (52%) ovulates spontaneously after LOD and a further 31 patients ovulated after giving them Clomiphene Citrate in a dose of 100 mg/day for five days starting from the third day of their menses. Giving an overall ovulation rate of 109 out of 150 (72%). One patient conceived with twins and six ended in early fi rst trimester miscarriage and two were
ectopic pregnancies.
Conclusion: LOD is successful in PCOS patients who failed to ovulate on Clomiphene Citrate. LOD is more cost-effective than
gonadotropin’s as a single treatment results in several mono ovulatory cycles, thus allowing multiple attempts at conception whereas one course of gonadotrophic therapy yields a single ovulatory cycle with the inherent need for intensive monitoring. LOD is currently recommended as a safe, efficacious and cost-effective alternative to gonadotropins for induction of ovulation in infertile, anovulatory Clomiphene Citrate: Resistant PCOS women without the risk of ovarian hyperstimulation syndrome or multiple gestations.
Sini S Venugopal
Genix Fertility Care, India
Title: Recurrent implantation failure mainly with reference: PCOS
Biography:
Sini S Venugopal has completed her MBBS from SCB Medical College, Utkal University and MD (O&G) from VSS Medical College, Sambalpur University, India. She is currently the Director and Chief Fertility Consultant of Genix Fertility Care, India.
Abstract:
Implantation is a complex synchronized endometrial blastocyst cross-talk. Human reproduction is a relatively inefficient process. The probability of conception is only 25-30% per cycle of all the pregnancies that are lost, 75% represents the failure of implantation. Recurrent implantation failure refers to the failure to achieve a clinical pregnancy after transfer of at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. There are multiple factors of recurrent implantation failure, mainly embryo factor, uterine factors, tubal factors, ovarian factors etc. In PCOS patients markers of uterine receptivity like ï¡Vï¢3 integrin, HOXA-10 and IGFBP-1 expression are decreased during the secretory phase. PCOS endometrium overexpresses androgen receptors and fails down to regulate estrogen receptor: α in the window of implantation. A thorough evaluation of both the female and the male partner is warranted to ascertain. Various treatment modalities to improve the chances of implantation like correcting uterine/tubal factors, endometrial coring, day-5 blastocyst transfer, assisted hatching have been explored. PGD/PGS is also done to improve the chances of implantation. Now personalized embryo transfer using a personalized window of implantation called endometrial receptivity array is also offered to patients with recurrent implantation failure. Time-lapse imaging of the cultured embryo may provide a complete picture of the developmental kinetics that the embryo undergoes. Applying this system, the morpho-kinetic parameters specific to embryos that are capable of implanting can be identified. The promising future options are gene therapy and endometrial stem cell therapy.