2014: What's new in Reproductive Medicine?
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Transcript of 2014: What's new in Reproductive Medicine?
What’s New???Reproductive Medicine
Gana Hospital
Why!!!
• To be updated• To modify
•
To share
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