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What’s New??? Reproductive Medicine

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What’s New??? Reproductive Medicine Gana Hospital


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Why!!! To be updated To modify To share


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Progesterone


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


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Progesterone for acute brain trauma


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


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Idea Progesterone after preterm labor For the preterm baby


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Why To protect the fetal brain To improve brain development


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Preterm fetus: Deprived from P4


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


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Genomic Sequencing The coming Era


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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


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Work flow of conventional versus second-generation sequencing


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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 ?


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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.


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Preimplantation Genetic Diagnosis (PGD)


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Which Embryo is Disease-Free?


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


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Towards Better Gene Therapy


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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


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Back to Simple Ideas


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


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LH surge is associated with FSH surge to a lesser extent


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Outcome?? 10% increase in PR??


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


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Increasing LBR with Diagnostic Hysteroscopy


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Dienogest 19-nortestosterone derivative Endometriosis Menorrhagia COC Pituitary suppression


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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.


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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??


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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.


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Thank you Professional Diploma in Reproductive Medicine


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