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Conceiving Ethics
Published in Michael van Manen, The Birth of Ethics, 2020
With medical innovation, at times we can overcome infertility. Many different assisted reproductive technologies are available: ovulation induction, in vitro fertilization (IVF), artificial insemination, intracytoplasmic sperm injection, and so forth. And yet, achieving pregnancy with such means poses risks. Multiple gestation pregnancies (twin, triplet, and so forth) while being associated with assisted reproductive technologies are also associated with preterm birth that carries its own complications (Kushnir et al., 2017; Sunderam et al., 2019). Even when precautions are taken to mitigate the risks of conceiving a multiple gestation pregnancy (such as single- rather than multiple-embryo transfer), preterm birth and congenital anomalies remain present as risks (Liberman et al., 2017). In other words, assisted reproduction would seem to demand we accept risks for a child even before we conceive him or her. What worry should we have when we knowingly place a child at risk in our efforts to conceive him or her? Should this future child not be first and foremost in our mind even before attempts at conception? Is this not the ethical imperative of conception?
Practice exam 5: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Risks to mother – miscarriage, GDM, PET.Risks to fetus – SGA, preterm delivery, shoulder dystocia, neonatal admission.Ovulation induction – OHSS, multiple pregnancy.
Ultrasonic Monitoring of Follicular Growth and Ovulation in Spontaneous and Stimulated Cycles
Published in Asim Kurjak, Ultrasound and Infertility, 2020
The most important complication of ovulation induction is hyperstimulation. It is characterized by multiple follicles and development of luteal cysts after ovulation. Ovarian enlargement is always present in such cases and can be well documented by ultrasound. Sonographic measurement of the ovarian size is much superior to the clinical estimations, and enables better distinction between the patients who developed mild or moderate hyperstimulation.67 However, mild to moderate hyperstimulation is regarded as an acceptable sequelae of ovulation induction, and does not cause significant complications except increased probability of multiple pregnancies (Figure 28).
Screening target genes for the treatment of PCOS via analysis of single-cell sequencing data
Published in Annals of Medicine, 2022
Zhenzhen Lu, Chunyan Chen, Ying Gao, Yanhui Li, Xiaojie Zhao, Hanke Zhang, Qiongqiong Wei, Xinliu Zeng, Yajie Li, Min Wan
The pathogenesis of PCOS and the development of ovulation disorders in this condition remains unclear. Metformin, however, is known to improve IR and ovulation. In the clinical setting, clomiphene citrate and letrozole are considered to be the first-line agents for ovulation induction [36]. Metformin reduces the risk of ovarian hyperstimulation syndrome, which together with ovarian laparoscopic surgery are used as second-line treatment [36]. Although the PGR progesterone agonist drugs have been studied in greater detail, methods of SIRT1 and ADAMTS1 modulation require further investigation. Besides it is difficult to collect oocyte from PCOS and control patients to do further validation, which is a limitation of our research, so it need to be validated by further subsequent studies.
Severe ovarian hyperstimulation syndrome induced by clomiphene: a case report
Published in Gynecological Endocrinology, 2022
OHSS is a serious complication caused by ovulation induction, which is related to the type, dosage, and treatment course of ovulation induction drugs. It is manifested as ovarian enlargement, ascites, blood concentration, hypercoagulability, and electrolyte disorder, and so on. Severe OHSS could cause serious complications, such as pleural fluid, acute renal insufficiency, and venous thrombosis. In this case, ovarian enlargement was present in this patient, manifested by the formation of corpus luteum cysts. In addition, pleural fluid and ascites were present due to increased capillary permeability. Although there was no renal damage or venous thrombosis, the symptom of obvious pleural fluid was classified as severe OHSS. The incidence of severe OHSS is low, and the incidence of severe OHSS in patients receiving ovulation induction therapy is about 0.1%-2% [1].
The reproductive endocrine feature and conception outcome of women with unknown etiological menstrual cycle (36–45 days) with long follicular phase
Published in Gynecological Endocrinology, 2022
Zhewei Wang, Jiongjiong Yan, Huifen Chen, Laman He, Shaohua Xu
The conceptional outcome in the LMC group was consistent with poor ovulation quality and other endocrine abnormality in the group. This reminds us that moderate early intervention is important for these women. As the incidence rate of infertility among married couples in China has gradually increased, the following measures are recommended for these women:The ovarian reserve function test such as AMH level test and AFC shall be performed for the women with ‘FSH/LH > 3’ to detect the occult DOR as soon as possible and relavant treantment may delay the occurrence of anovulation and prevent inferlity; Weight loss is recommended for obese patients to improve their insulin resistance.Doctors should investigate the etiology of ovulation quality in these women with ‘infertility’ in addtion to performing salpingography on them. Ovulation induction could be administered on women having small follicle ovulation or LUFS.For women who want to have children and have a history of spontaneous abortion, insulin resistance level and follicle monitoring could be implemented before pregnancy preparation, and pointly treatment could be carried out to improve follicular quality and luteal function so as to prevent the occurrence of recurrent spontaneou abortion abortion.