Methods: Asystematic literature search was performed using PUBMED for all English articles up to April 2014. Although this review mainly focuses on published human studies, it also draws attention to where future research should be directed based on animal studies. Results: Besides the 9 known mutations widely quoted for KS namely KAL1, Fibroblast growth factor 8 (FGF8), fibroblast growth factor receptor 1 (FGFR1), prokineticin 2 (PROK2), PROK receptor 2 (PROKR2), WDR11, heparin sulfate-6-O-Transferase (HS6T1), chromodomain helicase DNA binding protein 7 (CHD7) and semaphorin 3A (SEMA 3A), additional mutations in "FGF8 synexpression" group e.g., FGF 17, ILRD, DUSP 6, SPRY4 and FLRT3 have been shown to be involved in CHH, mostly KS besides SEMA 7A. Although traditionally division has been based on anosmic/normosnic criteria, further genes found to cause so called nIHH like Gonadotropin releasing hormone receptor (GNRHR). KISS1, TAC3, TACR3 have also been found to be associated with hyposmia on detailed testing on UPSIT and MRI for olfactory structures revealed absent OB. Further detailed examination of transcription factor genes have revealed involvement of HESX1, TSHZ1, AXL, SOX10 with a strong overlap of in transcription factors in development of septooptic dysplasia (SOD), combined pituitary hormone deficiency (CHPD) and KS. Treatment with rFSH/-hCG gives almost similar results to pulsatile GnRH therapy and should be based on cost factor, availability and in occasional cases specific treatment like kisspeptin therapy. Conclusions: Contrary to the traditional thinking, one shoud reconsider classifying cases of IHH simply on basis of anosmia/normosmia. Deafness calls for looking for mutations in Sox 10/CHD7/ILRD7 considering 38% associ-Open Access K. K. Kulvinder et al. 51 ation of former. Therapy should be individualized based on availability of pulsatile GnRH, cost factor and in recalcitrant cases kp therapy may be of use with kp mutations and NKB mutations.
With the recent advances in breast cancer treatment the 5 year survival rates have increased significantly with overall 20yrs survival in developed countries like USA. With further improvement being designed in the treatment of breast cancers with more and more sophisticated models to study breast cancer in human beings using the modern microfluidic models one expects more and younger breast cancer survivors to be needing fertility treatments. Here we review the modern advances in breast cancer treatments and the need for emphasizing on fertility preservation before starting any chemotherapeutic or other management as recommended by both ASO and ASRM. We further discuss the methods of fertility preservation in such young breast cancer patients or models without affecting there 5 years survivals we further report a case of HER2 positive breast cancer patient receiving multiple chemotherapeutic agents followed by radiotherapy where such treatment was not even discussed in a patient of primary infertility before starting treatment like chemotherapy and radiotherapy even in a developing country where cryopreservation of embryos or oocytes was possible just before the treatment if not preserving the ovarian tissue .Abstract
In cases of early ectopic pregnancy the only medical therapy advocated till now has been single or multiple dose methotrexates with some preconditions. Here the role of an aromatase inhibitor, letrozole is discussed as a novel drug that possibly can be considered for replacement of methotrexate in view of its simplicity of use, cheap, relatively free of side effects associated with methotrexate, not having many contraindications other than the haemodynamic stability, size of mass, ruptured ectopic pregnancy. Currently letrozole is being utilized commonly for the treatment of hormone sensitive breast cancer, besides as a drug for ovulation induction in cases of poly cystic ovarian syndrome (PCOS). Only more randomized controlled trials (RCTs) are needed before one can safely utilize it in routine clinical practice without fear of any haematological side effects of methotrexate.
The chances of live birth following in vitro fertilization (IVF) have plateaued despite lot of advances. A lot of extra therapies are available that suggest a lot of effectiveness in enhancing the success of IVF. The idea of this review is to detail whether any benefit is there regarding the add ones utilized with the idea of increasing endometrium receptivity. We included systematic reviews of randomized controlled trials (RCT’s) including separate trials. Basically 5 add ones were scrutinized namely Immune therapies comprising of corticosteroids, Intravenous Immunoglobulin (IVIG) Granulocyte-Colony Stimulating Factor (G-CSF), as well as intralipid, Endometrial Scratching; Endometrial Receptivity Array (ERA); Uterine Artery Vasodilation including Platelet rich plasma (PRP) as well as Intrauterine Human Chorionic Gonadotropins (HCG). The results point that no strong proof is there that such add on are efficacious as well as safe. Many of these are expensive and it is better to use that money for any treatment that has been proven by evidence. Need for large RCT’s as well as proper safety examination are a must before they get used during routine clinical practice.
The present ovarian cycle model posits that ovulation gets triggered by a crucially maintained escalation of estradiol. Nevertheless, a deep probing of the published literature besides the work of team of Dozortev, Diamond along with Pellicer, more specifically Dozortev DI demonstrated significant doubt about the relative parts of progesterone as well as estradiol in the event of ovulation. Here proof provided by Dozortev DI’s work is presented that gives so much proof regarding the part played by estradiol has been misrepresented till the day, whereas the actual ovulation trigger is the Luteinizing hormone independent preovulatory progesterone surge in the circulation to about 0.5mg/ml. Moreover the recent work accommodates with the present work on the capacity of progesterone for ovulation trigger with its clearly proven capacity of blocking ovulation at the time of pregnancy, or when delivered in the kinds of synthetic progestins in the form of Oral contraceptive pills in addition to the experimental results with regards to estradiol benzoate stimulates ovulation in the lack of progesterone.
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