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