5^th Asia Pacific Gynecology and Obstetrics Congress August 22-23, 2018 Tokyo, Japan

Biography:

Eunice has been an Embryologist in Singapore General Hospital since 2013 till date. She has received the letter of authorisation from the Ministry of Health to authorize her to perform procedures in the clinic.

Abstract:

Intra-cytoplasmic sperm injection (ICSI) is used in assisted reproductive technology to overcome male factor infertility. Ejaculated sperm is usually used for ICSI. In our Centre, surgically retrieved sperm is an option for patients who are Azoospermic, patients with high DNA fragmentation index and patients who are unable to give a fresh ejaculate sperm sample on the day of oocyte retrieval (OR). The techniques used in the surgical retrieval of sperm include Percutaneous epididymal sperm aspiration (PESA), Microsurgical epididymal sperm aspiration (MESA) and Testicular sperm extraction (TESE). This retrospective study compares the outcomes of ICSI using surgically removed sperm versus ICSI using ejaculated sperm in our Centre. From January 2016 to June 2017, a total of 308 couples underwent IVF treatment with ICSI using fresh sperm ejaculate. The sperm was selected for ICSI based on the morphology and viability. 19 couples underwent IVF treatment with ICSI using surgically retrieved sperm. The immotile testicular sperm was first activated using GM501 Sperm Mobil before selection for ICSI. For the group of patients using ejaculate sperm, the fertilization rate was 67.9%, embryo cleavage rate was 99.1%, and pregnancy rate was 40.9%. The fertilization rate for the group of patients using surgically retrieved sperm was 56.4%, embryo cleavage rate was 97.4% and pregnancy rate was 33.3%. In conclusion, the use of surgically retrieved sperm for ICSI gives comparable outcomes to the use of ejaculate sperm. This further alleviates the problem of male factor infertility in IVF and improves the success rate of IVF treatments.

Biography:

DR G K TRIPATHI

•       Founder Hon President :-

1.     Delhi State Chapter of ISAR

2.     Delhi State Chapter of ISPAT

•       Founder Hon Secretary  Azamgarh Obgy Society

•       Pioneer to start HANDS ON TRAINING MODULE FOR :-

-          Ovum pick up & Embryo Transfer Simulator

-          USG PHANTOM

-          Hysteroscopy Simulator/Phantom

-          PESA/MESA/TESA Hands on Goat Testis

Abstract:

Male infertility, a global concern issue & now a days lot of newer medical & surgical entities evolved to cure it.

Medically Clomiphene, CoQ, HCG inj and other micronutrients are in fashion to use.

Varicocele correction had effects on sperm count morphology and motality.

Micro surgical procedure -PESA /MESA /TESA /MICRO TESE for sperm retrieval.

Non-Surgical PRP has promising impact on Erectile Dysfunction.

Other surgical process ie Epididinostomy quite effective in correction of Andrology issues.

IUI/IVF.ICSI, an effective way to conceive.

New Modalities like SPERM ROBOT promising in non-motile sperm.

STEM CELL - great hope to correct Azoospermia in future.

Biography:

Dr Dalida Badla MD at the age of 27 years from faculty of medicine in Damascus and Alepo universities .D.MAS from World Association of Laparoscopic Surgeons in 2017 .Fellowship in Assisted Reproductive Technology at WLH,NCR Delhi in 2017 .she is head section of obstetric and gynaecology department in MEDICLINIC  AL Bateen ABU DHABI .she is member in MEFS and speaker in many conferences.

Abstract:

Loosing pregnancies before 20 weeks of pregnancy is a frequent obstetric complication  and has several  reasons  such as  parental chromosomal anomalies ,maternal thrombophilic disorders ,uterine structural anomalies ,and antiphospholipids antibodies .

In 50% of cases the pathophysiology remains unknown .the clinical association between RPL and PCOS is more than common however the incidence rate uncertain till now .the high LH and obesity are risk factor of spontaneous abortion hyperinsulinemia has been  proposed as pathway for the effect on obesity although its effect on androgen production(theory of INSULINE RESISTANS) as a key factor behind   PCOS /OBESITY and risk of RPL).  PCOS and miscarriages symptoms and how   to avoid miscarriages with PCOS , and the treatment  options,  then planning to get pregnant again after miscarriage 

Biography:

Dr Mai O.El gamal , Fetal medicine specialist with 6 years expertise ,member of ultrasound special care unit of the fetus Ain Shams University ,one of the oldest and biggest hospitals and educational institutes in Egypt and middle east

Experienced in female imaging with special interest in research and education, responsible for teaching and training doctors. Actively participated for 2 years in Ain Shams Obstetrics and Gynecology international conference (ASOGIC 19-20) and other local conferences and workshops

Abstract:

An ectopic pregnancy is defined as the implantation of a fertilised ovum outside the endometrial cavity; Condition is associated with high morbidity and mortality. With incidence of 2% and increasing as a result of an increase in the number of patients with risk factors as ART and PID also increasing diagnosis rates whoever Mortality rate is decreasing because of improved diagnostic techniques and heightened awareness among clinicians and patients.

Ectopic pregnancy of unusual locations account for 4% of all ectopic pregnancies associated with increased morbidity and mortality rates compared to usual tubal ectopic pregnancies. Advances in imaging techniques and high index of suspicion aid early diagnosis and intervention preventing catastrophic complications.

Presenting cases of: Advanced Abdominal ectopic, heterotopic pregnancy with monochorionic twin pregnancy located in tube, cervical ectopic, corneal ectopic and caesarean scar ectopic encountered during our practise each with its characteristic ultrasound picture.

Early ultrasound diagnosis of rare forms of ectopic aid proper management of patients    gives time for conservative measures especially when future fertility is of concern.  Prevent extensive surgeries which may jeopardise fertility and life threatening complications as rupture uterus, haemorrhage, DIC associated with undiagnosed cases.

Biography:

Dr. Tariq masood khan (mcps, mcps, fm, dcps, obg)

Family / emergency medicine specialist / internist

Student ms obs/gyn

Obstetrics and gynaecology department

Lady willingdon hospital lahore

Abstract:

Eclampsia is a life threatening condition with highest mortality and morbidity characterized by uncontrolled hypertension un-consciousness fits albumin urea in the setting the of Pre Eclampsia.

STUDY

An extensive elaborative study carried out from 2005 to 2009, to study the therapeutic and prophylactic role of Magnesium Sulphate and Diazepam in Eclampsia.

STUDY PERIOD

Four years 2005 to 2009

OBJECTIVE

To study MgSo₄ Vs Diazepam reducing MMR, NMR in Eclampsia

STUDY DESIGN

This was a comparative study. Total 500 patients of fulminent pre- Eclampsia / Eclampsia were studied included booked / un-booked patients attending Lady Willingdon Hospital were admitted evaluated assessed and put on MgSo₄ Vs Diazepam divided in two groups. The results were compared which showed of MgSo₄ as superior in efficacy of compared to Diazepam in improving over all mortality morbidity in Eclampsia.

MATERIAL AND METHODS

Total 500 patients of Eclampsia admitted and studied in Unit – 2 Lady Willingdon Teaching Hospital of King Edward Medical University Lahore managed in ICU according to a specially design proforma, protocol and were given MgSo₄ and Diazepam for control of fits, Hydralazine, Labetalol and Isoket infusions for lowering – blood pressure (MgSO₄) A+B. (Diazepam) with multi disciplinary involvement divided in two groups compared and followed up.

RESULTS

In Group-A there were 20 mothers and in Group-B 40 mothers died. It was observed that maternal mortality was significantly higher in Group-B women as compared to that of Group-A. i.e. (p-value=0.005) In Group-A there were 20 mothers and in Group-B 40 mothers died. It was observed that maternal mortality was significantly higher in Group-B women as compared to that of Group-A. i.e. (p-value=0.005)

CONCLUSION

The comparative study and of role of MgSO4 Vs Diazepam in reducing Mortality, morbidity in maternities, neoneties, efficacy showed the superiorness of Magenesium Sulphate as compared to Diazepam with out any doubt.

KEY WORDS

Therapeutic, Prophylactic role, Magnesium Sulphate, Diazepam,  Eclampsia 

Biography:

From 2010 to 2016 Dr. Romanov studied at the faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia. From September 2012 to October 2015 Dr. Romanov had been working as an assistant researcher in the Department of Biochemistry and Molecular Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University. Now he is undergoing last year of his residency in National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of the Russian Federation. Dr. Romanov is constantly working on developing his practical skills and also performs research on noninvasive methods of improvement effectiveness of assisted reproduction technologies. He regularly participates in scientific meetings on obstetrics, gynecology, perinatology and assisted reproduction technologies. 

Abstract:

According to in vitro experiments, up to 75% of morphologically normal human blastocysts cannot spontaneously leave the zona pellucida (ZP), which can lead to implantation failure.

The aim of the study was to identify predictors of human blastocyst hatching success in assisted reproduction programs.

Materials and methods. This prospective case-control study included 83 blastocysts - 36 blastocysts (43.4%) in group of spontaneous hatching and 47 blastocysts (56.6%) in control group.

Hatching success assessment was performed after 144–146 hours post fertilization. The expression of cathepsin V (CTSV), GATA binding protein 3 (GATA3) and human chorionic gonadotropin beta (CGB) genes were detected by qRT-PCR (“DNA Technology”, Russia).

Results and discussion. The efficacy of spontaneous hatching of human blastocysts are determined not by the quality of the ZP, but by the quality of the blastocysts themselves. The rate of blastocysts with the thickening or other defects of the ZP was similar in the two groups. High-quality embryos have enough adaptation possibilities for the timely release both from the normal and the thickened ZP. The quality of blastocysts on the fifth day of culture by Gardner classification was higher in the group of spontaneous hatching.

Expression of CTSV, GATA3 and CGB genes was higher in blastocysts in spontaneous hatching group, which was associated with high ICM and TE quality. This indicates that hatching is a special stage of blastocyst development, characterized by a chronological and chronogenetic determinism. This may be a mechanism that prevents the implantation of a defective embryo with retarded development or other development disorders. The expression of CTSV, GATA3 and CGB genes is lower in low-quality blastocysts, which does not allow them to commit spontaneous hatching and to implant into the endometrium.

Biography:

Dr. Akira Shirane is a gynecology and obstetrics  at kurashiki medical center , Japan 

Abstract:

The symptoms of intestinal endometriosis are especially severe such as dyschezia.

These symptoms negatively effect on the QOL of the women remarkably.

Surgeries are considered when medical therapy does not succeed or in the setting of infertility.

We evaluated symptoms, surgical procedures, post-operative recurrence and postoperative pregnancy rate.

Setting: Kurashiki medical center

Patients: the cases who were diagnosed with intestinal endometriosis and had surgeries

Designs: Retrospective cohort study

Interventions: Laparoscopic low anterior resection of Rectum plus alpha over ten years (from January, 2008 to December, 2017).

Result: We have experienced 23 fertility sparing surgeries(33.9±5.24 years old; mean ±SD) which are observed for more than six months. In 18 cases, patients complain of dyschezia. These symptoms significantly improved after surgery in all cases.

Recurrences were found in five out of ten cases without hormone therapy, while no recurrence was found in thirteen cases of hormone (dienogest, LEP)-administrated group.

Nine cases had a desired conception and seven were successful (two natural, five ART) in pregnancy and five acquired babies.

Conclusion: Many of patients desired babies before surgeries. However, once they have finished surgical treatments, they tended to hesitate to get pregnant for fear of a recurrence. For patients who try to have fecundity-sparing surgery, doctors should provide education regarding the high risk of recurrence and usefulness of the Assisted Reproductive Technology (ART).

Moreover, recently we encourage the patients to have preoperative oocyte pick up (OPU) and embryo freeze preservation because of these benefits as below.

1. Acquire frozen embryos that are more successful than fresh embryos in pregnancy rate

2. Provide patients the defined motivations toward surgery

3. Eradicate concerns of postoperative diminished ovarian reserve

4. Pregnancy is expected under the improved pelvic environment by surgery.

Biography:

Dr Dheeraj,is presently doing 3^rd Year Post graduation in M.S(Obstetrics and gynaecology) in Sri Rama Chandra Medical college,Chennai,one of the prestigious college in INDIA

He finished his under graduation from Andhra Medical College,KING GEORGE HOSPITAL,VISAKHAPATNAM in 2015

He is presently doing his research on the “MATERNAL HIGHLY SENSITIVE C REACTIVE PROTEIN AS PREDICTOR OF PRE ECLAMPSIA”

Abstract:

CASE DESCRIPTION-

Broad ligament haematoma is a rare complication following a normal vaginal delivery.

We report one such case of a woman who developed this complication within 3 hrs of normal vaginal delivery.

She is G2P1L1, 38 wks GA, in active labour.

 Pt was allowed for spontaneous progression of labour, following which she delivered vaginally. Within 3 hrs patient looked clinically very pale with vitals being deranged and complains of inability to void urine, severe perineal pain.

On basis of clinical examination and transabdominal ultrasound features a diagnosis of right sided broad ligament haematoma was made.

Based on patients haemodynamic instability surgical management in the form of obstetric hysterectomy was done.

DISCUSSION

Broad ligament haematoma is a relatively uncommon complication that can occur following a spontaneous vaginal delivery.

 It can be silent and not cause any obvious vaginal bleeding. Clinical symptoms are vague with persistent perineal pain, urge to defecate, unable to void within first few hours of delivery.

Imaging modalities like transabdominal ultrasound and MRI can help in confirming the diagnosis. It has been suggested that MRI depicts postpartum hemorrhage even in deep extraperitoneal regions where the hematoma is clinically non-apparent, and in addition it can delineate the extent of the hematoma.

Broad ligament haematoma can be managed both conservatively and surgically depending on patients haemodynamic status, size and rate of haematoma expansion.

Small non spreading ones can be managed conservatively however larger ones might need internal illiac artery ligation, UAE or even hysterectomy.

Our patient was haemodynamically unstable after confirmed diagnosis and given the circumstances that the haematoma was expanding we decided on the surgical management i.e subtotal hysterectomy.

Biography:

Eman A Elgindy, MD, PhD (Maastricht University, the Netherlands)

Professor Obstetrics and Gynecology, Zagazig University, Egypt. Director of Rahem Fertility center, Egypt.

Abstract:

PCOS is the most common endocrine disorder in women, with a prevalence of 15% when Rotterdam criteria are applied. Three ESHRE/ASRM PCOS Consensus Workshops were performed.  They put outlines for diagnosis, evidence-based treatment and women’s health aspects of PCOS. In current presentation, there will be an emphasize on the first 2 workshops guidelines. Reconsideration of some of these guidelines will be addressed in accordance with the up to date evidence and best practice approaches 

Biography:

Dr. Kais Razzouk
Breast Surgery - Breast Reconstruction
Gynecological surgery
Gynecological and mammary cancerology
Nice Santa Maria Breast Institute

Abstract:

Introduction:

Breast reconstruction after total mastectomy and irradiation is a real challenge for the surgical teams. And is a crucial step for the patient in the life after breast cancer. The effect of radiotherapy on the skin often leads to preferring the reconstructions by flaps. However, reconstructions by prosthesis carries a high risk of complications and unsatisfactory cosmetic results. The optimization of skin trophicity by lipofilling and its positive impact on the results of secondary prosthetic breast reconstruction led us to perform an autologous fat grafting prior to secondary implant breast reconstruction after mastectomy and radiotherapy.

Patients and method:

All patients were treated at the same center between 2012 and 2015. They all had a total mastectomy and irradiation. They all had one or more sessions of lipofilling prior to breast implant reconstruction. Patients were followed to collect this data: postoperative complications, prosthesis removal, cosmetic result, and tumor recurrences. Results: Fifty-four patients were included. The mean pre-pectoral lipofilling session was 1.1 (1-2). The average volume of fat injected is 150cc (80-250). The average time between the end of treatment and the first session of lipofilling is 20.4 months (3-60). The mean volume of the prosthesis is 400cc (290-620). The mean follow-up time is 22 months. No local tumor recurrence was reported. One patient had a cutaneous necrosis after lipofilling. Implant explantation was performed in three cases (5.5%). The mean cosmetic result is 4.7 (3.5-5).

Conclusion:

Pre-pectoral lipofilling prior to implant breast reconstruction improves the chances of success by optimizing the trophicity of the skin. It significantly reduces the risk of prosthesis explantation.

We consider that this technic is a way for a minimal invasive breast reconstruction.

Biography:

H.M. Youssef

Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt,  Mansoura IVF-ET Center 

Abstract:

A 34 years old gravida three para 1, presented for the first time to our department at 14 week gestation with single living cervical ectopic pregnancy. The patient was admitted and the diagnosis was confirmed. Following counseling and a written informed consent obtained for hysterectomy the patient was scheduled for surgery. Laparotomy was done and a loop was applied on the anterior division of the internal iliac arteries on both sides. The peritoneum of the lower uterine segment was dissected to expose the cervix and to free the urinary bladder. Both uterine arteries were ligated. A c-shaped incision was done on the upper part of the cervix, the fetus was gently and easily extracted and the cervix was digitalized to manually remove the placenta. The cervical canal was explored and an intra-cervical balloon tamponade was applied. The anterior division of the left internal ileac artery was ligated and the loop on the right internal ileac artery was removed because the bleeding was controlled. The patient received 2 units of packed RBCs. The postoperative period passed smooth and the catheter was deflated gradually after 2 days. The patient was followed up by β-HCG estimation after discharge until it became negative

Biography:

Dr Sujoy Dasgupta is currently working as a Consultant in Reproductive Medicine & Surgery at Genome - The Fertility Centre, Kolkata, India. He has his expertise in evaluation and passion in improving the fertility treatment and reproductive health. He presented papers and posters in various national and international conferences. He has been invited to deliver lectures in more than 40 conferences at regional, national and international levels. He has, to his credit, 15 research publications at national and international journals and chapter contributions in three text books. He takes keen interest in medical education, particularly for trainee doctors. He has also been involved in “MRCOG Orientation programme” for training the doctors aspiring for MRCOG. His area of interest includes male subfertility, recurrent pregnancy loss, low cost IVF and fertility treatment in sexual dysfunction.

Abstract:

Statement of the Problem: Semen analysis is an integral part of evaluation of a subfertile male. Because a semen result reflects the genital tract health of a man three months prior to collection, there is risk of significant day to day variation. Additionally, the results vary from one laboratory to another. In 2010, the WHO published recommendations on standard reporting of semen analysis. A number of Western studies found the lack of uniformity among the laboratories in assessing and reporting semen samples. Our study looked into the adherence of reporting of semen analysis with the WHO 2010 guidelines.

Methodology: An observational study has been carried out after collecting semen analysis reports from different parts of Eastern India and Bangladesh. The sources of the reports included individual patients presented to subfertility clinics and gynaecologists, reports sent by the patients online to their treating doctors and directly from the laboratory. The reports were subsequently analyzed against the standard of semen sample reporting recommended by the WHO, 2010.

Findings: Majority of the laboratories did not follow all the standard points laid down by the WHO. Although all of the laboratories mentioned sperm concentration and morphology, majority of them did not report motility properly. Regarding physical characteristics, there have been discrepancies in reporting pH and viscosity. Very few laboratories used reference values, and among those who the values, large portions were still not using the WHO 2010 criteria. However, most of the laboratories attached to the ART (Assisted reproductive Technology) clinics performed better in terms of reporting than non-ART laboratories.

Conclusion & Significance: Even more than seven years after publication of WHO 2010 guidelines for semen analysis, majority of the laboratories do not adhere to the all the recommendations. There is need for increased awareness for the laboratory persons in this regard. 

Biography:

Diana Thomas is the Founder and CEO of The World Egg Bank. In 1985, she graduated magna cum laude with a M.A from Arizona State University.  After her experience with unexplained infertility, she had to find her own egg donor in the 1990s when this option was uncommon. She quickly discovered that there was a desperate need for a company that understood and empowered recipients with information and choice. She began one of the first egg donor agencies in the US.  In 2004, her egg donor agency evolved with the new technology of freezing eggs, and The World Egg Bank was formed. She has delivered thousands of donor eggs to potential parents around the world. 

Abstract:

Egg donation has been offered through IVF clinics in the US since the 1980s, but at a rare and infrequent rate. The original technology used for egg donors was difficult for both the egg donors and the recipients. The US Center for Disease Control (CDC) first began reporting egg donation cycles in 1996, the year I had my first child through egg donation, making my son one of the first 100 babies born from donor eggs in the US. In 2004, The World Egg Bank opened the first ‘commercial’ and independent egg bank in the world. By 2009, we shifted from slow freeze to vitrification technology, with Dr. Masashige Kuwayama’s vitrification and warming technology. This has allowed egg banking to become a simpler process for the recipients, making it a more popular choice for intended parents. With the increase of fertility clinics operating their own egg banks the search for a donor has become less complicated. However, it still raises the question about quality and consistency.

The World Egg Bank’s model is unique amongst all other egg banks.

§  We manage all donor processes from our own state of the art medical facility.  Our centralized model ensures we conduct all donor screening, stimulation, retrievals, and ova vitrification with optimized protocols and experienced laboratory systems and staff in our singular location. We do not run a multi-service infertility practice, nor do we hire outside clinics to manage donor cycles, perform retrieval or vitrify our ova. 

§  Our focus is entirely on providing quality donor ova. We have the highest consistent quality banked donor ova available in the US because all donor processes are managed by the same highly trained staff.

§  We have been shipping donor ova since 2004 and have been recruiting and screening donors for more than 23 years.

§  We support the recipient’s clinic at the time of first ova warming by sending one of our highly-trained embryologists to verify and assist with our protocols, at our expense.

§  We have a large roster of over 400 donors with thousands of ova already banked, ready to ship.

§  Our donors meet FDA, HFEA (UK), Canadian and Australian compliance requirements. Our laboratory is nationally certified, including specific requirements set by the states of New York and California.

§  We are science driven. Our stimulation protocols, vitrification technique, shipping system, and all related technical and operational systems are monitored to optimize outcomes.

§  The vitrified ova are shipped directly from our laboratory to any clinic laboratory that can accept imported ova, where the clinic will perform the warming, ICSI, culture, transfer, and embryo cryopreservation.

Biography:

Biologist with more than 7 years of experience as an embryologist in different in vitro fertilization clinics. At the moment I am part of the team of Minifiv in Madrid. We are a clinic specializing in natural cycle protocols and low ovarian stimulation.After years of working in the IVF laboratory, I became interested in nutrition and healthy habits and their involvement in fertility. With a master's degree in nutrition and health, whose master's work was a bibliographical review of the "importance of nutrients in the periconceptional and gestational period." Nowadays, I am training as a technical dietician, acquiring the knowledge to promote healthy habits indispensable for optimize reproductive health.

Abstract:

About 15% of couples at childbearing age have problems conceiving. There are many factors against which we can not fight as advanced maternal age, but there are others in which we can intervene, including a healthy nutrition. The relationship between optimal nutrition and fertility is demonstrated repeatedly throughout the scientific literature.

Parental nutritional status is able to intervene in the success or failure of the reproductive stages and even in the results of assisted reproduction techniques. They are involved in metabolism pathways regulating the activity of enzymes, signal transduction, transcription and oxidative stress.

The most important consequences of unhealthy nutrition or the presence of parental obesity includes menstrual disorders, infertility, miscarriage, and obstetric complications as well as mistakes in spermatogenesis, DNA fragmentation, and epigenetic changes in the methylation patterns generated in early development.

Inadequate intake of nutrients as the group of B vitamins, folate and methionine are capable of modifying DNA methylation patterns and produce mistakes ingametogenesis, fertilization, quality and embryo development, implantation and pregnancy ongoing, predisposing the offspring to different diseases.

We will carry out a review of the consequences and implications that has the dietary habits and certain nutrients throughout the reproductive stages and their relationships gene-nutrient through epigenetic mechanisms.

A new discipline emerges for the study of the dietary influence in gene expression, through changes in the epigenome: the nutri-epigenomics. Future research are needed to understand the link between DNA methylation, micronutrients intake and future consequences in the development stages. Define epigenetic biomarkers can help us to identify and prevent the risk and develop individual therapies such a nutritional interventions based on individual epigenetic profiles.

The most promising strategies are education and individual efforts with proper knowledge of healthy habits. Being the main objective the prevention of obesity and not the treatment of it and its consequences.