About new directions for optimization of procedure EKO

[angela]

Kind time of day everything, Boris. Would like to hear your opinion on here such saying:

*quot; On a high hormonal background probably strengthened coagulation of a blood that can prevent to get accustomed to an embryos in view of a bad blood flow (density of a blood). And so on opredelnnye days (the doctor knows) you hand over a blood on a hemostasis. If -means vso with blood OK. If giperkoaguljatsija-then register to prick fragmin or a heparin. To that that. But it is very serious parameter. And quot; ()

In advance thanks.

[boris]

Uv. angela!



Really at application of Gonadotropinums probably change of rheologic properties of a blood (in particular at a syndrome of hyperstimulation of ovaries, as a variant) and occurrence of microthrombuses in vessels endometrija. Studying of this question activly, how much or as far as I know, are engaged in NTS AGiP. Now these researches are not routine and can will be applied in centres of science. My personal opinion does not miss opinion of your attending physician. In due time I carried out researches of microcirculation endometrija and is valid differences in a blood flow have been received. As therapy already now series of the centers in program EKO include antikooguljanty (or inhibitors of Thrombinum so is more correct) or the preparations, having similar an effect (Aspirinum).

[angela]

This opinion not my doctor...

You could not prompt, for example you, appoint or nominate Aspirinum to all clients or for purpose or appointment analyses of a blood during EKO are necessary, or appoint or nominate on any external, we shall tell or say so, to factors?

[boris]

Considering an opportunity of the above described complications as their prophylaxis, personally I appoint or nominate low doses of Aspirinum without carrying out anaizov bloods.

[angela]

:)

[angela]

Kind time of the day, dear Boris Aleksandrovich!:)

It would be desirable to hear your opinion on some questions:

1. I heard, that in the Europe instead of dekapeptila apply new preparation Sinarel, speak, that at him there are less than side effects and chance on implatatsiju above...

2. You would advise to hand over what analyses of immunologic character at unsuccessful attempt EKO?



In advance thanks.

[boris]

Uv. angela!

1. I heard, that in the Europe instead of dekapeptila apply new preparation Sinarel, speak, that at him there are less than side effects and chance on implatatsiju above...

I have no personal experience of application of this preparation.



2. You would advise to hand over what analyses of immunologic character at unsuccessful attempt EKO?

If were not spent prior to the beginning of procedure, a blood on AFAT and the AsAT.

[beloborodov]

A little it is not clear, that to what the AsAT.



But it would be desirable to talk about a principle. In some centers EKO it is accepted to spend the first attempt without the profound inspection. In some centers - on the contrary, try on a maximum at once. Has how much understood from the above-stated discussion and from a life - there is a popular tendency *quot; aOy*quot; and to survey, if attempt EKO was unsuccessful.

sdes it is necessary to think of following positions.



1) As is known, a unitary episode primary nevynashivanija pregnancy - yet the reason for careful inspection and treatment as it is known, that on 95 % the reason in chromosomal aneuploidies and other genetic nevezuhe. And to consider or count pair problem it is possible only after more than two episodes nevynashivanija. A question - pochemy after EKO we consider or count pair worthy our deep research mind or wit already after the first failure.



2) As is known, under laws of statistics, the probability of conception in first, second and third attempts EKO decreases a little, and thus gathers additionally up to 60-70 % for three attempts at women of genesial age (statistics on the foreign centers with average efficiency of 20-25-30 %). And only from 4 attempts the probability starts to decrease sharply and the schedule becomes close to a plateau already to 6 attempt.

Question so only after 3 unsuccessful attempts it can is possible to consider or count, that is necessary for a steam still poobsledovat and to treat.



Let's politely reflect.

[beloborodov]

Possible or Probable depression of by-effects is connected simply by that a preparation vveditsja not by injections, and by a spray for a nose.



Data about improvement of implantation are doubtful.

The preparation in Russia is not registered. Significant advantages before existing in the market has no.

[angela]

- how much or as far as I have understood antispermalnye an AsAT is an antibody.

*quot; the Question so only after 3 unsuccessful attempts it can is possible to consider or count, that is necessary for a steam still poobsledovat and to treat. *quot;



If to me the doctor has suggested to make 3 attempts, and then already to survey and find out the reason of failures - I would replace the doctor at once. Business not in the material party or side, though too not the unimportant fact, and in moral and physical.

From my unsuccessful attempt has passed or has taken place month, but I till now wake up also the first idea - *quot; why it has not turned out? *quot;

I am afraid, that with such approach the number of patients in psychiatric clinic will increase.

To understand that is created at statesticheskoj *quot; Nn???U*quot; in a head the one who has passed or has taken place through it can only.

[beloborodov]

With all over again too has thought, that the AsAT - antibodies to semens., but has then stopped short - their analysis when it is a question about EKO if the fertilization occurs or happens what for is necessary. I think, Boris will explain to us.



As to your emotions, I quite understand them.

But will agree, it is strange. Though it is difficult to demand from the patient in psychologically complex or difficult position of full sobriety of reasonings. That is you want not suspension, validity and rationality in approaches to your treatment. You want ritual dances, deep, as more as possible intricate researches more. Process, instead of result is really important.

At sufficient experience of the gynecologist, he and the usual smear will take so, that all secret of your illness will seem as if now raskoroetsja.

We here speak about additional inspections, such as microbiology, an immunology, gemostaziologija, the expanded endocrinology, additional invasive or aggressive and operative vmeshatelsta.

Now I understand more and more, that was wanted by one patient. It or she had one failure on EKO, and she well simply begged to direct on perfect or absolute besploleznyj to its or her situations plazmaferez. Present, what abrupt this treatment when from you take away pair litres of a blood seems and then longly pour in, pour in, and around of a tubule, kolbochki. The head is turned.

I do not laugh at all, on the contrary it is very a pity thousand pairs which are worn on a circle to earn-analyses-treatment-earn-inspection...

[Melnichenko]

Angela, it is possible, I shall support or maintain Sergey?

It seems to me, that normal conversation of people respecting each other (the doctor and fruitless pair before EKo) necessarily should contain following section - dear spouses! As a result before the spent inspection (it is possible with the short comment, that this section meant) we have found out, that others, besides EKO, methods of treatment of sterility or barrenness in your case are unacceptable. (As I not in delight from ONO???a*quot; expanded Y?nO???u?n*quot; - I am afraid, that I guess, that behind it or him costs or stands....., I shall bring still a retort which .nadejus .dolzhna to sound - ' diseases sobstveno endocrine system which could prevent to conceive or bear or conceive or take out to YOU a fetus at EKO, are absent *quot; - if I have not so precisely formulated idea, Sergey will correct for me).

But, .dorogaja our pair, - method EKO does not guarantee 100 percentage probabilities of absolutely happy end, and there is no your FAULT that there can be a failure (she can occur or happen and at spontaneous conception). You make a decision on a method of treatment, and, as well as in any decision accepted by people, always there is an element of possible or probable failure at execution or performance of the decision .slovom, the informed consent of the patient (or pairs or steams) at decision-making on treatment - quite good if to reflect, a thing.

Believe, that Sergey speaks about imitation of rough medical and diagnostic activity, it is a lot of sense...

[angela]

No, I will agree with you cannot.

To me the result is important during. And it is quite normal, when the patient wishes to know the true reason of the failures.

I do not wish to waste time, forces and agents that through year to learn or find out, what all was in vain because of any gemostaziologii (et I so, for example) That will change for three attempts, for example, if the reason in any immunologic factor which to all stirred or prevented and caused all failures?

And about ritual dancings - for 7 years I am a lot of them have seen, some of your colleagues, it is successful with it or this consult, however if so to approach or suit - that unsuccessful attempt EKO it is possible to accept too for ritual dance. As only the doctor and embriolog vljadejut a situation, instead of the patient...

*quot; Though it is difficult to demand from the patient in psychologically complex or difficult position of full sobriety of reasonings. And quot; - OH, IT'S NOTHING, my failure yet has not given reason!:)) as they say: *quot; not n?nNON?y*quot;:)

[angela]

2

*quot; Believe, that Sergey speaks about imitation of rough medical and diagnostic activity, it is a lot of sense *quot;

Here no doubt. I agree and I believe, as it have passed or have taken place on own experience, in very known clinic in Moscow. Even to recollect I do not want: (

But during too time - to do or make nothing during 3 cycles EKO, too not an output or exit.

If to recognize that the doctor skilled or experienced, does not untwist on money, alas, such factor meets, he will initially appoint or nominate those purposes or appointments which really will help or assist to reach or achieve result.

Or I am not right?:confused:

[boris]

Uv. Sergey!



The question on necessity and sufficiency of researches before procedure EKO not once rose. Two years ago as a result of year job of leading experts in this area main principles of inspection of fruitless pair have been formulated. I well remember three-day discussion of this document (which I hope it will be issued as the ministerial order) in Saratov. The points of view were the most polar: from *quot; all from the God and to do or make nothing ?O??*quot; up to *quot; a hourly capture of hormones at carrying out of stimulation oO?n??*quot;.

I have already stated the opinion and I consider or count, that there are no bases to spend a parallel between research at nevynashivanii pregnancy and sterility or barrenness, hence absence of implantation in first attempt EKO already is the basis for carrying out of additional inspection. In this case experience of the doctor should prompt VOLUME and METHODS of additional inspection. Art of doctoring is not only knowledge of statistical probability of offensive or approach of this or that phenomenon. The psychological component of a question as you probably know, has here important value or meaning;importance. Probably to you the facts spontaneous beremennstej come or stepped are known after spouses refused treatment of sterility or barrenness and took the child on education (that removing or taking out stressornyj the factor of sterility or barrenness). Undoubtedly, it is a field on which the mass of unfair people and simply charlatans from medicine blossoms, but to sweep aside it or her too it is impossible.

I think, that the unequivocal answer to this question will receive very much and very difficultly.

[V.Dvorianchikov]

*quot; As is known, under laws of statistics, the probability of conception in first, second and third attempts EKO decreases a little, and thus gathers additionally up to 60-70 % for three attempts at women of genesial age (statistics on the foreign centers with average efficiency of 20-25-30 %). And only from 4 attempts the probability starts to decrease sharply and the schedule becomes close to a plateau already to 6 attempt. And quot;

25-30 % are in the best clinics of the world, as that: in the Great Britain or in Slovenia. At that, probability of conception - by no means, not probability of a birth of the healthy child. And all this bosh, that the probability does not decrease from attempt to attempt. Such statistics can be received, unless, *quot; not a?ao*quot; a part of repeated attempts which have been under the agreement of parties executed under a full or partial guarantee of result and have ended with failure. But even at the most pink 30 %- 3 attempts give conception of all from 65 % of probability.

At ours vshivenkih 10-15 % on call (Mr. Kamenetsky will not allow to tell lies in the smaller party or side), through 3 attempts leave 27-38 %, i.e., no more than one chance three-four for three attempts and without any guarantee, that 9 months in *quot; ?N*quot; will not be reflected on health of the child.

It is remarkable, that arguing about hormones and enzymes, anybody from g-n osemenitelej and has not mentioned with a word about infections. And they, in effect, also are the unique real reason of sterility or barrenness. And if someone in it or this doubts, let will show or present even one fruitless pair without chlamydias and mycoplasmas.

Well, as about *quot; ?anO?aOy?n*quot; (or it is better - *quot; nO?aOy?n*quot;)?



P.s. The AsAT (nuclear heating plant) is aspartataminotrasferaza.

[boris]

I do not wish to press with you in discussion since I know prospects of its or her development. It is unique would like to learn or find out: whence at you statistics on VRT? Can can result or bring a reference on the primary source? Such impression, that you read old zhurnalchiki (90th years) from regional library from a popular scientific department *quot; I Want all ??aOy*quot;

[V.Dvorianchikov]

Statistics from the most different sources. Including, and from former patients of different foreign clinics. As if to domestic statistics, it, as usual, business dark: patients the truth at us nobody will tell or say. Some revelations on this bill came across in an Internet, something I can assume on an example of local clinics (but there, apparently, in general - mraki). But, by your retort, I, if and *quot; ?oOa?*quot; that not strongly and, probably, aside overestimate.

However, not finding similar methods perspective, I do not trouble myself with warehousing of links this subject. You do not collect statistics by efficiency of exsanguinations!:)

[boris]

: (To smile not to that Mr. Dvorjanchikov!

You do not collect statistics by efficiency of exsanguinations!



... And, notice, not disktiruju on this subject



B.Kamenetsky

[V.Dvorianchikov]

Sounds, as entreaty about mercy.

Good, I shall not put you in awkward position and to ask how much or as far as I *quot; ?oOa?*quot; and in what party or side. I, in fact, understand, is how much strong you are dependent on the niche and the *quot; ?N?N?a*quot;.

I shall be glad, if you will comprehend one simple thing: the lion's share of your failures occurs or happens from not distinguished or recognized or ignored infektsionki. So to become the most productive clinic in the world, it is necessary for you practically nothing - osemenjat exclusively not infected women, and a semen to take from not infected men.

However, if you will follow to these wishes, is very fast among a greater part of potential clientele there will be a question: *quot; and what for in general it is necessary to us, if, dezinfetsirovavshis, in most cases it is possible to become pregnant and natural way? *quot;

[beloborodov]

To Boris



Thanks big for the answer.



You write: *quot; there Are no bases to spend a parallel between research at nevynashivanii pregnancy and iN??n?N?*quot;



But why you consider or count, that nevynashivanie and sterility or barrenness so the distant friend from the friend. After carry to a cavity of the uterus of embryoses we can quite consider or count the fact nenastuplenija pregnancy as the fact nevynashivanija, because the reasons the same as up to absence of implantation, and the broken or disturbed implantation. I can not remember though one reason nevynashivanija early terms which could not cause otsutsvija implantation. And time of the reason and a pathogenesis - is uniform why to not spend a parallel and in strategy of inspection and treatment.



With necessity of psychological influence I completely agree the patient, but it seems to me that there are more effective methods of the psychological help, than some analyses.





PS:

I suggest to declare or announce boycott to that.