2014: What's new in Reproductive Medicine?

What’s New???Reproductive Medicine

Gana Hospital

Why!!!

• To be updated• To modify

•

To share

Progesterone

Brain

Progesterone can be produced in the brain from steroid precursors.

they have been found to have neuroprotective function.

Progesterone for acute brain trauma

Progesterone & Preterm la-bor

Mainly for prevention of preterm labor

But still there are many preterm labor

Liable to cerebral palsy and delayed neural development

Idea

Progesterone after preterm labor

For the preterm baby

Why

To protect the fetal brainTo improve brain development

Preterm fetus: Deprived from P4

Trottet et al, 2012

First case preterm baby having progesterone therapy

Future

Genomic Sequencing

The coming Era

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

Work flow of conventional versus second-generation sequencing

1. Prepare genomic DNA 2. Attach DNA to surface 3. Bridge amplification 4. Fragement become double stranded5. Denature the double stranded molecules6. Complete amplification

• Illumina• ABI SOLiD• Roche 454• HeliScope

What is next-generation sequencing ?

7. Determine first base8. Image first base9. Determine second base10. Image second base11. Sequence reads over multiple cycles12. Align data.

1 billion bases per run, 1% of the cost of capillary-based method.

Preimplantation Genetic Diagnosis (PGD)

Which Embryo is Disease-Free?

Non Invasive Prenatal Diagnosis

• Minimise the need for amniocenecis• Cell free DNA (fetal in maternal blood)• High accuracy

Towards Better Gene Therapy

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

Back to Simple Ideas

High dose FSH at hCG triggering

• Novel concept• Give four ampoules of FSH at time of hCG

injection• Why??????

LH surge is associated with FSH surge to a lesser extent

Outcome??

•10% increase in PR??

Corifolitropin alfa

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

Increasing LBR with Diagnostic Hysteroscopy

Dienogest

• 19-nortestosterone derivative

• Endometriosis• Menorrhagia• COC• Pituitary suppression

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.

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??

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.

Thank you

Professional Diploma in Reproductive

Medicine