Advancements in IVF and Urogynaecology: Insights into Reproductive Health

1. ObG Watch June 2005

2. Louise Brown...Then & Now

3. 25 Years of IVF

4. 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

6. 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

7. Britain's First Human Clone

8. Robodocs start ward rounds! RP6 Robots Sr Mary & Dr Robbie Start Ward Rounds from 18 May 05 at St Mary Hospital, London Face to Face interface with Consultant far away

9. Needle Suspension for SUI Systematic Review - Cochrane library Feb 2004 9 Trials – 347 women – 9 Different NS Procedures Abdominal 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

10. Oral Pills in Urogynaecology

11. 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)

12. 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

13. Tolterodine L-tartarate Reduces Urinary Frequency Reduces Urgency

14. DESMOPRESSINControls Nocturia • Minirin 0.1 mg OD • Potent Antidiuretic • Reduces Nocturnal Voids • Better sleep

15. Parameters for Prediction of Caesarean Section

16. 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 Postrcaldwell & Moloy 1933 Variables

17. Occipito Posterior & CS • CS Rate of 30-42%-Sizer&Nirmal 2000 • Disproportion due to Deflexion-Floberg et al 1987 • Inadequate Head to Cx Forces – Lessuterine activity-Allman et al 1997 • Increased Fetal Distress: Decelerations • Longer labor • Increased rate of Augmentation

18. 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 a case for Admission USG?

19. Premature Ejaculation

20. 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”

21. 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

23. Dapoxetine • Anti depressant • Increases Sexual Stamina (IVELT) 3-fold • Will earn J&J $400 million by 2007 Am Urol Assocn 24 May 2005

24. Thank you!