- Email: [email protected]
32 Proximal tubal occlusion (PTO)
S106 30 Poor responders
9th Annual Meeting, Mediterranean Society for Reproductive Medicine
different ovarian stimulation options
32 Proximal tubal occlusion (PTO)
T. Motrenko Human reproduction Department, Hospital Danilo I, Cetinje, Montenegro
M. Pansky Endoscopic Unit, AsafHarofe Medical Center, Zerifin, Israel
There is no clear definition of poor responders, but failure to archive multiple follicular developments after ovarian stimulation and at least 3 mature oocytes in IVF cycle is most widely used criteria. The incidence among treated patients is between 15 25%, and it is demanding task to choose stimulation protocol in order to improve IVF result. Two major group of patients are women in advanced reproductive age and young poor responders mostly because diminish ovarian reserve. Numerous tests could be used to predict poor response on COH like Inhibin B, early follicular phase estradiol, ovarian volume, but most accurate are: day 3 FSH, AFC, anti-Mullerian hormone, and the most certain predictor is previous IVF cycle with poor ovarian respond. Standard GnRHa long protocols with increasing starting dose of gonadotropins, agonist flare up protocols or GnRH antagonists protocols didn’t improve IVF cycle result, even results are slightly better in flare up and antagonist cycles. Natural cycle IVF presume many attempts, and certainly cost less. Combined Clomiphene or Letrazole and gonadotropin stimulation is another treating option. Agonist-antagonist conversion protocol is not widely used. Growth hormone addition may improve result, but significantly increase cost. LH addition for rFSH stimulation in late follicular phase show beneficial effect. Also, LH priming before stimulation in modified long protocol could increase pregnancy rate for young poor responders. Many stimulation protocols are still under evaluation without clear evidence of benefit for poor responder’s patients and randomized, well designed studies are needed to develop ideal protocol for treating this group of patients.
Introduction: Proximal tubal occlusion (PTO) occurs in 10 25% of women with tubal disease, and is mainly due to amorphous materials (mucus plags, debris ecc.), chronic salpingitis, salpingitis isthmica nodosa (SIN), intratubal endometriosis, tubal polyps or spasm. Fallopian tube assessment, an essential part of an infertility work up, is still synonymous with the performance of either hysterosalpingography (HSG) or a laparoscopy and dye test although some more advanced methods like hysteroscopy and sonohydrosalpingography (SHG) were recently described as less invasive alternatives. Many different treatments were described, starting from selective radiographic catheterization and cannulation, hysteroscopic and tactile cannulation, macro and microsurgical tubocornual or tubo tubal anastomosis via laparotomy or laparoscopy and in vitro fertilization (IVF). Methods: Relevant reports on the pathophysiology of PTO, different diagnostic modalities, different treatment modalities and pregnancy rates according to the primary tubal pathology and mode of treatment were reviewed. Results: The total and ongoing pregnancy rate (PR) for micro and macro surgery were 50% and 36% respectively. For the radiographic cannulation methods and direct hysteroscopy methods the PR was 30% and 48% respectively. Conclusions: Selective salpingography and trans cervical cannulation under fluoroscopic or hysteroscopic guidance are effective at establishing patency in appropriately selected patients and are less invasive and costly than the surgical alternatives. Surgical methods should be considered when the first line cannulation techniques fail or in cases where reversal of sterilization in needed or tubal fibrosis is evident. With appropriate treatment, and in the absence of other infertility factors, these patients may anticipate a likelihood of ongoing pregnancy of 50%. The decision about when to choose IVF instead is not only a pure medical one, but also a matter of availability, cost, age and sometimes cultural and religious belief.
31 The reproductive significance of the fallopian tube mucosa D. Ovrang Reproductive Medicine, University of London, United Kingdom Effective tubal transport of ova, sperm and embryos is a prerequisite for successful spontaneous pregnancy. Although there is much yet to be discovered about the mechanisms involved, it is evident that tubal transit is a far more complicated process than initially thought. Propulsion of gametes and embryos is achieved by complex interaction between muscle contractions, ciliary activity and the flow of tubal secretions. Evidence is accumulating of the important and possibly preeminent role of ciliary motion in this process; and this review describes current knowledge about ciliary activity and its physiological regulation. There is also a description of the effects on ciliary function of various pathological states, including smoking, endometriosis and microbial infection, and how altered ciliary activity may impact upon fertility.
33 The ethics of patient-friendly ART G. Pennings Bioethics Institute Ghent, Ghent University, Ghent, Belgium Introduction: The single embryo transfer policy of the last decade was the first step in the direction of the global transformation of the practice of medically assisted reproduction. The next step in this evolution is the rise of mild stimulation IVF.
9th Annual Meeting, Mediterranean Society for Reproductive Medicine
different ovarian stimulation options
32 Proximal tubal occlusion (PTO)
T. Motrenko Human reproduction Department, Hospital Danilo I, Cetinje, Montenegro
M. Pansky Endoscopic Unit, AsafHarofe Medical Center, Zerifin, Israel
There is no clear definition of poor responders, but failure to archive multiple follicular developments after ovarian stimulation and at least 3 mature oocytes in IVF cycle is most widely used criteria. The incidence among treated patients is between 15 25%, and it is demanding task to choose stimulation protocol in order to improve IVF result. Two major group of patients are women in advanced reproductive age and young poor responders mostly because diminish ovarian reserve. Numerous tests could be used to predict poor response on COH like Inhibin B, early follicular phase estradiol, ovarian volume, but most accurate are: day 3 FSH, AFC, anti-Mullerian hormone, and the most certain predictor is previous IVF cycle with poor ovarian respond. Standard GnRHa long protocols with increasing starting dose of gonadotropins, agonist flare up protocols or GnRH antagonists protocols didn’t improve IVF cycle result, even results are slightly better in flare up and antagonist cycles. Natural cycle IVF presume many attempts, and certainly cost less. Combined Clomiphene or Letrazole and gonadotropin stimulation is another treating option. Agonist-antagonist conversion protocol is not widely used. Growth hormone addition may improve result, but significantly increase cost. LH addition for rFSH stimulation in late follicular phase show beneficial effect. Also, LH priming before stimulation in modified long protocol could increase pregnancy rate for young poor responders. Many stimulation protocols are still under evaluation without clear evidence of benefit for poor responder’s patients and randomized, well designed studies are needed to develop ideal protocol for treating this group of patients.
Introduction: Proximal tubal occlusion (PTO) occurs in 10 25% of women with tubal disease, and is mainly due to amorphous materials (mucus plags, debris ecc.), chronic salpingitis, salpingitis isthmica nodosa (SIN), intratubal endometriosis, tubal polyps or spasm. Fallopian tube assessment, an essential part of an infertility work up, is still synonymous with the performance of either hysterosalpingography (HSG) or a laparoscopy and dye test although some more advanced methods like hysteroscopy and sonohydrosalpingography (SHG) were recently described as less invasive alternatives. Many different treatments were described, starting from selective radiographic catheterization and cannulation, hysteroscopic and tactile cannulation, macro and microsurgical tubocornual or tubo tubal anastomosis via laparotomy or laparoscopy and in vitro fertilization (IVF). Methods: Relevant reports on the pathophysiology of PTO, different diagnostic modalities, different treatment modalities and pregnancy rates according to the primary tubal pathology and mode of treatment were reviewed. Results: The total and ongoing pregnancy rate (PR) for micro and macro surgery were 50% and 36% respectively. For the radiographic cannulation methods and direct hysteroscopy methods the PR was 30% and 48% respectively. Conclusions: Selective salpingography and trans cervical cannulation under fluoroscopic or hysteroscopic guidance are effective at establishing patency in appropriately selected patients and are less invasive and costly than the surgical alternatives. Surgical methods should be considered when the first line cannulation techniques fail or in cases where reversal of sterilization in needed or tubal fibrosis is evident. With appropriate treatment, and in the absence of other infertility factors, these patients may anticipate a likelihood of ongoing pregnancy of 50%. The decision about when to choose IVF instead is not only a pure medical one, but also a matter of availability, cost, age and sometimes cultural and religious belief.
31 The reproductive significance of the fallopian tube mucosa D. Ovrang Reproductive Medicine, University of London, United Kingdom Effective tubal transport of ova, sperm and embryos is a prerequisite for successful spontaneous pregnancy. Although there is much yet to be discovered about the mechanisms involved, it is evident that tubal transit is a far more complicated process than initially thought. Propulsion of gametes and embryos is achieved by complex interaction between muscle contractions, ciliary activity and the flow of tubal secretions. Evidence is accumulating of the important and possibly preeminent role of ciliary motion in this process; and this review describes current knowledge about ciliary activity and its physiological regulation. There is also a description of the effects on ciliary function of various pathological states, including smoking, endometriosis and microbial infection, and how altered ciliary activity may impact upon fertility.
33 The ethics of patient-friendly ART G. Pennings Bioethics Institute Ghent, Ghent University, Ghent, Belgium Introduction: The single embryo transfer policy of the last decade was the first step in the direction of the global transformation of the practice of medically assisted reproduction. The next step in this evolution is the rise of mild stimulation IVF.