June 2005
IVF-ET: Past, Present & FutureHoward Jones Jr
ObG Survey 2005
• 1.3 to 1.5 Million IVF Babies in the World – 1% of Births in USA
• Indication: Tubal Disease / Endometriosis / Male Factor
Future of IVF
• Non invasive detection of Oocyte with potential to achieve Singleton
• PGD to overcome Chromosomal aberration
• Fusion of Meisis-induced Somatic cells
• Exogenesis
RP6 Robots Sr Mary & Dr RobbieStart Ward Rounds from 18 May 05 at St Mary Hospital, London
Face to Face interface with Consultant far away
Needle Suspension for SUI
Systematic Review - Cochrane library Feb 2004
9 Trials – 347 women – 9 Different NS ProceduresAbdominal Retropubic Suspension Vs NS:
Failure after 1 year: 16% Vs 29%Morbidity same
Anterior Vaginal Repair Vs NS:Failure: 36% Vs 33% (Same)
Conclusion: NS probably not as good as Abdominal Suspension
More Studies needed
DULOXETINE for Stress Incontinence
• Selective Serotinin (5-HT) & Nor Epinephrine Reuptake Inhibitor• Rhabdosphincter
Activity• Efferent Pudendal nerve Activity• Pelvic Floor Tonus
Marketed as “ULOZET” -40 mg bd (Inca)
-Urol 2004;6 (Suppl 3)
RCT: BJOG March 2004
• 494 women• 40 mg bid x 4 weeks• Incontinence
Episode Frequency (IEF) reduced by >50%
• Incontinence Quality Of Life (I-QOL) Improved after 4 to 12 weeks of treatment
Tolterodine L-tartarate
Reduces Urinary FrequencyReduces Urgency
DESMOPRESSINControls Nocturia
• Minirin 0.1 mg OD• Potent Antidiuretic• Reduces Nocturnal
Voids• Better sleep
Parameters for
Prediction of Caesarean
Section
Variables
• Parity ( more in Primi )
• Height: 5% at 170 cm Vs 30% at 140 cm McGuinness & Trivedi 1999
• Increased Maternal Age Main et al 2000
• Male Fetus: Delayed maturation of Sympatho adrenal system = Less catecholamine during hypoxia & acidosis Lieberman et al 1997
• Anthropoid pelvis: Occ.Tr & Occ Postr caldwell & Moloy 1933
Occipito Posterior & CS
• CS Rate of 30-42% -Sizer&Nirmal 2000
• Disproportion due to Deflexion -Floberg et al 1987
• Inadequate Head to Cx Forces – Less uterine activity -Allman et al 1997
• Increased Fetal Distress: Decelerations
• Longer labor
• Increased rate of Augmentation
USG Diagnosis of Occ Postr in Early labor to predict CS
-Nicolaides et al Int J ObG June 2004
• 601 cephalic singletons at onset of labor• Vaginal Delivery 86% & CS14%• CS in Occ postr 19% Vs Non OP 11%• Conclusion:
Diagnosis of Occ postr at onset useful predictor of CS among other parameters
Intra Vaginal Ejaculation Latency Time ( IVELT )
Definition:
”Persistent or Recurrent ejaculation with minimal sexual stimulation before during or after intromission and before the man wishes it”
IVELT
• Systematic Review of 21 RCTs
• 79 Publications between 1944 & 2003
• Incidence: 31%
• Traditionally Treated with Antibiotics / Neuroleptics / Anti depressants
• Anti Depressants effective
Waldinger et al Int J Impotence Res 2004
Dapoxetine
• Anti depressant
• Increases Sexual Stamina (IVELT) 3-fold
• Will earn J&J $400 million by 2007
Am Urol Assocn 24 May 2005
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