Freedom of the air

 The freedom of the air is a group of commercial aviating rights that grant the airlines of a country the rights to get into land of the airspace of other country. It was made in 1944 by many international associations such as the Chicago Convention known as the Convention on International Civil Aviation. The international commercial aviation route network is the fundamental association that helped in forming the freedoms of the air. The nine freedoms of the air are: 1. The right for flying over foreign country but without making landing in this country. 2. The right for being refueled and get maintenance in foreign country through travelling the way to another country. 3. The third is the right to fly from one's own country to another country. 4. The right to fly from a foreign country to the own country. 5.The right to fly between two countries during flights while the flight begins or ends in the own country. 6. The right to fly from a foreign country to another while stopping in one own country without technical reasons. 7. The right to fly between two foreign countries while not offering flights to one's own country. 8. The right to fly between two areas in a foreign country while continuing service to own country. 9. The right to fly into a foreign country while not giving service in own country. The possible reasons to make the freedoms of the air in the world of commercial aviation are related to logistics and other economic reasons such as advantages in communication and international cooperation in shipping.

 

Question 2

How can you analyze the impacts of breach of air freedoms to Qatar by GCC countries and Egypt?

The crisis in Qatar had left many passive impacts on the economy and logistics of Qatar as the breach lead many countries to cut diplomatic relations with Qatar such as Yaman, Liybia and Maldives. This also affected its trade movement as closing these countries' borders lead to decrease in exporting and importing and reduced Qatar global business and links with many other different countries. The problems of Qatar with these countries also affected its entering water boarders with other areas and land boarders as well, this made the movement of Qatari passengers more difficult and delayed than before. This lead to traffic revenue losses by Qarat airways and to many businesses in Qatar and related to it. 

What do you recommend to minimize the traffic revenue losses by Qatar airways? Support your recommendations with reasons.  

In order to reduce the traffic revenue losses by Qatar airways, it is then recommended to provide cheaper air flights to new areas where the airway lines are shorter in order to encourage travellers to go there. This is based on views of Dwell, (2017) who confirmed the need to change airway destinations when needed and according to the amount of revenue loss as it is important to innovate and provide new travelling solutions for customers. Another thing is to improve the customer experience within the air flight in order to reduce the passive effect on passengers who have to spend more time as a result of changing the air way paths.  

 

 

 

 

 

 

References

1.     Dwelle, E. (2017). ' How to improve airline operational performance and disruption management.' https://www.sabre.com/insights/how-to-improve-airline-operational-performance-and-disruption-management/

https://pomeps.org/wp-content/uploads/2017/10/POMEPS_GCC_

Business in a global context HSBC

 

Introduction

Business in a global context today has made business organizations face many challenges and higher competition levels. This global competition has made organizations innovate in their management strategies, leadership styles and services in order to reach competitive advantage and improve their performance. Most companies today are working on an international level in order to reach higher profitability and achievement. Working in such a global context makes it difficult to boost the market and reach competitiveness easily so business organizations try to apply techniques of global management and make use of the cultural diversity in the work environment. There are many challenges facing any business that is done in an international work environment or in a global context as there are many strategies for enhancing business in a global context and they should be based on deep analysis and evaluation. (Kalkan, 2011) The current paper is analyzing and evaluating the marketing strategies of HSBC bank Oman through applying the principles and practice of business in a global context and how the bank is employing its resources and internal and external capabilities and growth.

Analysis of the company's growth and performance

Since the many financial crisis that spread all over the world, banks internationally tried hard to protect their industry and market share as well as improving their growth level and performance. HSBC has been one of the most important international banks that is trying to keep and improve its level of growth and performance. HSBC Oman improved its internal and external capabilities in order to improve its growth and performance, the bank has added many services and updated its current services to boost the banking and financial market in Oman. First of all, the bank provided many opportunities for helping drive major projects in Oman such as providing trading facilities for Al Fairuz trading and contracting company as the bank provided it with a special loan system for purchasing its equipment. HSBC provides the company with an invoice discounting facility that is invaluable when it comes to managing the delayed payment challenges that can arise on major infrastructures projects. Projects of this type added too much to the bank's name and reputation internationally as the company is dealing with suppliers from all over the world. (Businesshsbc, 2017)

The bank has also added many services that provided different solutions for customers and attracted them in order to invest with HSBS. It provides many investment solutions that can help small and big investments grow and make profits. Examples are the global payables and global receivables the bank has delivered to its customers. The bank provided its customers with new electronic payment solutions in order to improve the way they manage their capital. The bank helped customers increase the efficiency of their operations by providing them with new services such as personal banking, internet banking, mobile banking and a variety of cards and ATM services that suit all needs and are easy to be accessed by all available means. The bank has been trying to raise its efficiency by raising its capitals through clients' investments in the bank's projects. The bank has been facing a profitable growth challenge by tailoring many liquidity solutions that suit the local market regulations and the bank has tried to raise profits and investments, for example, during the last 3 years total fines of RO 32,410 were imposed on HBON and its Pakistan operations for regulatory penalties. This amount comprised of fines of RO 30,000 levied by the CBO relate to procedural, delegation of powers, policies and operational issues relating to integration. The Chairman has responded to the CBO and a Board approved action plan is in place to rectify the issues. Fines equivalent of RO 2,410 were levied by State Bank of Pakistan on HBON's Pakistan operations relating to operational issues.   The bank is also trying to make business with other banks and raise deposits and thus profits as according to the bank's report of 2014, aggregate deposits held with commercial banks registered a significant increase of 10.9% to RO17.3 billion in December 2014 from RO15.6 billion a year ago. Government deposits with commercial banks increased by 10.1% to RO5 billion, while deposits of public enterprises reduced by 6% to RO0.88 billion during the same period. Private sector deposits, which constituted 64.7% of total deposits with commercial banks, increased 13.5% to RO11.2 billion in December 2014, from RO9.9 billion a year ago. The bank's external capacity is also high and effective as the bank is raising its efficiency of operations by managing its cash on a portfolio basis that includes about more than fifty international markets as the bank's global liquidity solutions include a variety of investment, self-funding and deposit techniques. The bank will tailor its liquidity solutions and will restrict them in order to be compliant with the regulations of the local market and not to restrict the services' availability. The bank approaches combines both effective information system and consistent services to be integrated easily in the business of any investing organization and the bank also includes a great management system that supports key clients' processes such as payable and receivable. (HSBC Annual Report, 2014)  

SWOT Analysis of the company

Strengths The bank depends on strong human resource management and high efficient human resources who are trained on the latest banking systems and techniques. HSBC presents many services and investment solutions including internet banking, personal banking and liquidity and liability. The bank deals with many international companies and have very strong clients from all over the world. The bank has a wide range of global liquidity solutions and is trying to be tolerated with the local market regulations. The bank provides its clients with guarantees and insurance systems. The bank has a variety of payment methods. The bank has strong infrastructure that provides many projects and facilities to its clients. The bank is increasing its operational finance to be working capital. The bank has a strong information system that is highly secured and protected. The bank depends on a strong effective net dealing with its customers via strong and efficient customer service team that uses the internet and mobile services to connect with clients and meet their needs.

Opportunities The bank has many opportunities for attracting more clients from Oman and form other countries as the bank provides a variety for solutions suitable for investment and projects. The bank has effective services that are strong and fast and can ensure accurate and safe delivery to boost other market rivals. The IT systems of the bank is stronger and updated than others in the market. The bank can expand its businesses in the area of the Middle and Far East depending on the success it made with companies in these areas. Realizing the margins in line with the risks taken. The bank can make expansion of anti-cyclical investments.  It can also add some management activities to encourage human resources innovate. It can also build new client relationships via the internet and social media. It can broaden its product portfolio and enhancing cross-selling activities. Boosting HSBC reputation to be regarded as a reliable partner in the international transport industry in the Gulf area and Middle East and MENA area.

Weaknesses The bank is in need to apply other different types of banking systems such as Islamic banking services such as Shariah services. The bank is in need to provide solutions for big companies that need big loans for great projects and the Omani law and regulations restrict them. The bank needs to train its human resources on updated Information Technology and updates in the banking services. Online contact with client need to be stronger. The bank need to find more effective means of communication with customers online such as chatting or social media sites. The bank needs to present more tax free solutions for its clients.

Threats Imbalance in currency prices especially the US Dollar compared to Omani Riyal. Problems in the global financial markets that may affect foreign investments. The rivals of the market especially those electronic banks such as PayPal and Moneybokers and others that provide easy transaction solutions and easy online purchasing. Development of the prices of goods locally and internationally. Differences in clients' needs and purchase movement. The updated technology that changes daily in all fields and in banking fields in particular. The rising threats of recession. The employees' turnover that is based on the expatriate employees in the bank as this affects the human resources management in the bank and the customer services. The effects that are occurring on the bank's net interest margins that may happen due to early payments and other financial activities in the bank. (Ommani, 2014)

 

Effects of competitive advantage

Wang, (2014) discussed how competitive advantage can be reached by the business organization and what features can show the organization has competitiveness over its rivals and how the organization can reach competitive advantage. He explained that there are determiners that the organization can seek in order to measure its competitiveness as he mentioned The Market-Based View (MBV) of strategy that argues that industry factors and external market orientation which are the primary determinants of firm performance and how the organization can find out the operations and activities it should focus on in order to increase competitiveness. This was also confirmed by Hana, (2013) who added that innovation can bring in competitive advantage to the business organization and it should be based on the market needs and that technological improvements can add features to the competitiveness of the organization in addition to cooperation and identified production routes. 

HSBC depends on different areas of business in order to achieve competitive advantage as the bank focus on its industrialized operations as the bank exerts great efforts on cost reduction so as to protect its margins. The bank has different local and international projects that are meant to develop its resources and encourage clients to invest in it. Clients' satisfaction is aimed at the industrialized operations of the bank through the streamlined processes and the compensation strategy the bank is delivering for its clients in order to reinforce their required sales behaviors. Another area of interest in the bank is the asset protection strategy as it is mainly focused on by the bank in order to ensure competitiveness. The bank is trying to move to compliance in order to ensure it is one of its business activities and this raises clients' trust and confidence in the bank's business and raise competitiveness. The bank tries to protect its asset through improving risk management capabilities. The bank also has effective management of the technology based risks as many clients fear investing in such a high technologized environment and this raises effectiveness and competitiveness of the bank. Leadership is also well trained to implement such technology and make full use of it and encourage clients to invest using it. Stability of the bank's operating platforms also encourages clients to trust the bank and invest in it. Another important area of competitiveness the bank focuses on is the delivery transformation as the bank gives much interest and support to the mobile payments and mobile network operators as well as emerging innovators as this increases the investment levels with the bank. The bank's digital services are very strong and much more important than others found in different banks. Another area for competitiveness the bank focuses on is the return on capital as the bank tries to reshape its own competitive landscape by increasing opportunities for clients to have high benefits and profits as well as helping the economy of Oman generally to be improved through the services and projects the bank delivers to its clients in Oman as this increases revenues and raises the bank's competitive strength.    

Ethics and corporate social responsibility

Harrison et al, (2015) discussed how the stakeholder theory can be an effective ethical approach for effective management, they referred to the need to support the organization vi stakeholders' support as the organization has to regard all stakeholders' needs and meet them and treating them morally and give much care to the business ethics and corporate social responsibility. They also confirmed that the business ethics is related to good management and lead to higher financial performance. This was also mentioned by Litz et al, (2008) who added that the theory sheds the light on corporate negligence of some organizations and that this leaves a big impact on stakeholders and on the organization's name, the organization should give much care to issues related to ethics and the environment and that leadership should be effective strategist in dealing with issues relevant to stakeholders. They added that stakeholders should be classified into groups and each group should receive the proper interest by the business organization. This will reflect on the organization through the support of stakeholders and raising its reliability. Legislated access to information by stakeholder is one of their rights and they should have full awareness of the organization's activities and interests, projects and aspirations for future of the organization and stakeholders' welfare. Stakeholders' support can be gained by building a bridge of trust between leadership and the stakeholders. The firm performance should include developing its performance related to ethics and corporate social responsibility. 

The HSBC board gives much importance to a very high standard corporate governance that is able to create a bigger value on the long term for the bank's stakeholders based on the bank's strategic goals. There are some main principles that the bank's ethics and corporate social responsibility are based on including the bank's financial strength, risk management, giving care to the environment, speed and accuracy, informing stakeholders and high competitive levels of performance as well as the high quality of the services. The bank depends on integrating resources and allocating them to the welfare of both the bank and the clients and the Omani and global society as stakeholders include all elements in these areas. The bank has governance policy that depends on effectiveness of the bank's board of directors and its clear vision and strategic direction for development. The bank also sponsors many charity and social events in Oman and globally in addition to many other projects that provide welfare and benefits to the local and international society.   

Reflective summary

The current paper discusses how HSBC Oman bank can represent a good example for working in a global context, the bank has many ways it is growing through such as the different facilities and project aids it presents for Al Fairuz trading and contracting company including the special loan system for purchasing its equipment. Growth also depends on the high technologized services the bank presents to its clients such as personal and internet banking as well as the online services and ATM machines services. The bank also has many strengths and opportunities that can improve its position in the market and improve its performance such as its strong information system and customer service as well as opportunities in the Middle EAST AND Far East where the bank can expand its business and projects. The bank yet faces some threats and suffers some weaknesses such as the need to apply different types of Islamic banking in order to meet the clients' needs related to Islamic banking. Threats include the changing prices of currency especially the US Dollar compared to the Omani Riyal and other currencies. The bank is very keen on ensuring competitive advantage through different services and projects that add too much to the Omani economy and by industrialized operations, international projects, stability of revenues, high profits, risk management capabilities, asset protection, technologized environment, delivery transformations, mobile services and internet banking. The bank focuses on ethics and corporate social responsibility in order to maintain all stakeholders' interest and satisfaction, this includes employees in the bank, clients and local and international society, stakeholders are well informed about the bank's activities and they have enough awareness related to the services the bank provides the Omani society with. The bank is a sponsor for many charitable projects in Oman and worldwide in addition to social events as well. The bank depends on strategic goals to meet the expectations and aspirations of stakeholders. The bank is recommended to add new service such as Islamic banking services and innovate in the current services it has. The bank is asked to compare other rivals such as those online banks including PayPal and Moneybokers and try to add services they have to the bank's clients online in order to make transactions easier and faster and more secured. The bank is recommended to train its human resources, give them new compensation system and retain them with different means in order not to turnover and cause loss to the bank or represent threats. The bank is asked to increase its CSR activities and share in more social and educational events in Oman and internationally in order to achieve more competitive advantage in such a global context.    

 

 

 

 

 

 

 

 

 

 

 

 

 

References

1.      Businesshsbc, (2017). 'Helping drive major projects in Oman.' http://www.business.hsbc.co.om/en-gb/article/helping-drive-major-projects-in-oman

2.      Hana, U. (2013). ' Competitive Advantage Achievement through Innovation and Knowledge.' Journal of Competitiveness. Vol. 5, Issue 1, pp. 82-96, March 2013 ISSN 1804-171X (Print), ISSN 1804-1728 (On-line), DOI: 10.7441/joc.2013.01.06

3.      Harrison, J. Freeman, E. Abreu, M. (2015). ' Stakeholder Theory As an Ethical Approach to Effective Management: applying the theory to multiple contexts.' http://www.scielo.br/pdf/rbgn/v17n55/1806-4892-rbgn-17-55-00858.pdf

4.      HSBC Annual Report, (2014). 'Annual Reports and Accounts 2014.' HSBC Bank Oman S.A.O.G.

5.      Kalkan, V. (2011). ' Knowledge Management Challenges For Global Business.' International Business and Economics  Research Journal.' https://www.cluteinstitute.com/ojs/index.php/IBER/article/view/3623

6.      Litz, R. Laplume, A. Sonpar, K. (2008). ' Stakeholder Theory: Reviewing a Theory That Moves Us.' http://journals.sagepub.com/doi/pdf/10.1177/0149206308324322

7.      Ommani, A. (2014). 'Strengths, weaknesses, opportunities and threats (SWOT) analysis for farming system businesses management: Case of wheat farmers of Shadervan District, Shoushtar Township, Iran.' African Journal of Business Management Vol. 5(22), pp. 9448-9454, 30 September, 2011 Available online at http://www.academicjournals.org/AJBM ISSN 1993-8233 ©2011 Academic Journals  http://www.academicjournals.org/article/article1380639652_Ommani.pdf

8.      Wang, H. (2014). 'Theories for Competitive Advantage.' https://ro.uow.edu.au/cgi/viewcontent.cgi?article=1410&context=buspapers

9.      http://www.hsbc.com.kw/1/2/!ut/p/b1/04_SjzQ0sDQ3sTAyMzDSj9CPykssy0xPLMnMz0vMAfGjzOIN3I1D_UINDYJdDHw9QjzNfQwcLQzAAKggEqjA2d3RwwQobGBhamFo4OnoEWpuFuxiZOBoTEi_n0d-bqp-blSOBQB4yIFP/dl4/d5/L2dJQSEvUUt3QS80SmtFL1o2XzBHM1VOVTEwU0QwTUhUSTdPUFE2MDAwMDAw/

10.  http://www.hsbc.co.om/1/2/om/personal/banking/current-savings-account/mobile-banking

Sohar Port

 

The port presents many services such as it allows smooth and efficient freezone and berthing with high efficient services to the vessels there. The port has a control office that provides good communication service. The following services are presented in the port:

Pilotage and Tug services

The port has an international team of pilots who are highly professional and experienced, they are responsible for operating and manning the Sohar port 24/7. They exert great efforts for ensure safe maneuvering in the Port area with the help of well-equipped tug boats of the great reputed company Svitzer.  

Linesmen and Household Waste Reception: 

The port has the waste reception office that is very important and make it unique in delivering services of discharging the wastewater that may be either industrial or domestic wastes.

Oil Spell Recovery (Land and Sea)

The port has the service of oil spell recovery on the land and in the sea. SOHAR port has a very active role in being a leading regional pioneer of ship-to-ship transfer services in its anchorage areas. Currently there is high demand for floating storage solutions, ship-to-ship movements of liquid bulk and this makes it important to use Sohar Port instead of other ports. Sohar port is provided with high measurements of safety and environmental protection. Sohar port has the strictest and most policed environmental policies in the region and this includes under and over the water. It has also invested in a very important project which is the artificial reef project that is meant for helping grow fish stocks and protect them in the region and area around Sohar port as well as helping in supporting the local fishermen. This is very good for the shipping lines as it ensures higher safety rather than other ports.

Port of Sohar in compared to Port of Duqm

Port of Duqm’s is a developed one in the Gulf area. It is planned in stages and needs more development as it is being developed on stages. Under the joint venture concession agreement concluded with the Omani government, Port of Duqm Company will oversee the initial phases of the gateway’s development. The port on the long term will help in the Omani economic growth. Sohar port on the contrary is already developed and has its own Freezone is a deep-sea Port and Freezone in the Sultanate of Oman that is managed by Sohar Indus as it trial Port Company (SIPC), this is a 50:50 joint venture between the Sultanate of Oman and the the Port of Rotterdam. 
There is a long-term vision for Duqm port development, Duqm Port has been built for providing services for some of the largest cargo vessels in service today. Sohar port presents cargo vessels services as its freezone is composed of 4500 hectare development and it is able to attract many international investments that are estimated with US $ 25 billion. Sohar port is considered one of the fast growing ports in the world as there is enough space for filling up fast and there are about 26 companies that are already reaping the benefits of unrivalled access to land, low-cost energy, and high skillful workforce.

References

1.     Portduqm. "Maritime services.' (2017).  https://www.portduqm.com/Business/Maritime-Services.html

2.     Soharportandfreezone. (2017). 'Overview.' http://www.soharportandfreezone.com/en/about/overview

3.     http://www.steinweg.com/uploads/oman/Map_oman.pdf

4.     http://www.soharportandfreezone.com/en/media/news-events/54

 

 

Procedures for infertility treatment

In vitro fertilization

In Vitro Fertilization is a fertilization process that is applied on the egg that is combined with the body's sperm but outside it as it is made into glass. This process includes many procedures such as monitoring the ovulatory status of the woman and it removes an egg from her ovaries in order to make them fertilized by the sperm in liquid and the process is made in the laboratory. IVF is a kind of reproductive technology that is assisting in treatment on infertility where a fertilized egg is being implanted in the uterus of the surrogate and then the result is a child that is not related genetically to the surrogate. This process is banned in some countries and others regulate it.  (Hansen et al, 2017)

Medications

There are many fertility drugs that are used lonely as basic types of treatment for inducing ovulation. They may fail as therapy to be used solely so then assistance reproductive procedures can be used with them. Examples are in vitro fertilization for producing more eggs.

There are main three types of fertility drugs which are:

•           Medications for Ovarian Stimulation:

There is the Clomiphene that can be Clomid, Serophene, generic. There is also Letrozole  that is referred to as Femara, ]; human menopausal gonadotrophin (hMG) [Humegon, (FSH) [Follistim, Gonal-F, Bravelle]; and luteneizing hormone (LH) [Luveris. (Mayoclinic, 2017)

•           Medications for Oocyte Maturation:

 Human chorionic gonadotropin (hCG) [Profasi, APL, Novarel, Pregnyl  and Ovidrel

The following table shows treatment for infertility based on the patients' cycle using Clomid:

Figure 2                               

•           Medications to Prevent Premature Ovulation:

 GnRh agonists [leuprolide (Lupron, generic), goserelin (Zoladex)]; nafarelin (Synarel), Gn RH antagonists, ), cetrorelix (Cetrotide )]. [ganirelix (Antagon.

Clomiphene

 

Clomiphene citrate referred to as (Clomid, Serophene, generic) is always used at first and it is mainly prescribed for the women suffering infrequent periods and or suffering long menstrual cycles. This drug is gentler than other potent drugs which are usually used in superovulation as it is based on blocking estrogen and tricking the pituitary through the production of follicle-stimulating hormone as well as the production of luteinizing hormone (LH). This is important in follicle growth and eggs releasing.

Clomiphene that is usually taken orally through the mouth, very inexpensive, and it bears multiple births risk estimated with a percentage of (about 5%, mostly twins) which is a percentage that is lower than its possibility with the usage of other drugs.

The following conditions can make the women have better chances with this drug:

•           Polycystic ovarian syndrome (PCOS

 •          having ability for menstruation but their menstrual cycle is irregular.

While the following conditions can make women have low chances with the drug:

•           Infertility but having normal ovulation

•           Having Low estrogen levels

•           Suffering Premature ovarian failure

The patient takes one or two daily tablets and this continues for five days and it begins after two to five days of the period. After a week of taking the last pill, ovulation occurs. In case that there is no ovulation, the patient should take higher dose in the next cycle. When this system is not effective too, there should be more prolonged treatment and the patient should take additional drugs and medicines as 6 cycles are the limited period suggested for this treatment by doctors. The quality and amount of cervical mucus can be reduced by Clomiphene as this can make the uterine lining thinner. In this case, the patient should take different drugs to retain thickness. This drug has some side effects such as headache, fatigue, weight gain, hot flashes and nausea.

figure 3

Figure 4

Metformin9,12

Polycystic ovary syndrome (PCOS) is a known hormonal condition that makes women produce higher increasing amount of androgens that then leads to irregular, or no ovulation. Metformin has been used for restoring cyclic ovulation and menses in some cases of women who are suffering from PCOS, though it is lowering the higher increasing blood glucose levels. AEs of metformin has within increased gastrointestinal discomfort, and that medication is contraindicated in some specific patients with the renal dysfunction. (Fodina et al, 2016)

Gonadotropins

This drug is another choice instead of Clomiphene or if it is not effective with the patient, Gonadotropins contain many kinds of drugs based on the FSH as a lonely component or on either combination of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). It works in an indirect way to make the ovaries able to produce the multiple follicles.

Gonadotropins are given to the patients through injection and it includes the following components:

•           Human Chorionic Gonadotropins (hCG)

•           Human Menopausal Gonadtropins (hMG), that is also referred to as menotropins

•           Follicle Stimulating Hormone (FSH)

•           Gonadotropin-releasing hormone (GnRH) analogs, which include GnRH agonists and GnRH antagonists

Gonadotropin can be natural compounds that are got from the urine or they can be synthetic compounds formed mainly in a laboratory with the help of recombinant DNA.

Human Menopausal Gonadotropin (hMG).

These drugs are also referred to as menotropins. They include different components such as the LH and FSH and all are derived from postmenopausal women urine. It is taken as injections in series after the start of the period with 2-3 days.   The period of giving the injections to patients is about 7 to 12 days. If there is no ovulation, time is extended.

Human Chorionic Gonadotropin (hCG).

 Human chorionic gonadotropin (hCG) resembels LH. It is like the LH surge that urges the follicle for eggs releasing. Natural hCG drugsare repared from pregnant women urine and they include Pregnyl, Profasi, Novarel, and APL.

The only existed genetically modified hCG drug is Ovidrel which has lower side effects as being injected, it is more able for control than the natural drugs. It is usually used after the usage of either hMG or FSH for stimulating the follicles final maturation stages.

Follicle Stimulating Hormone (FSH).

Urofollitropin referred to as (Bravelle, Fertinex) is a form of FSH which is purified, it is deriving from postmenopausal women urine. Follitropin drugs (Gonal-F, Follistim) are considered synthetic versions of FSH. Sometimes these drugs are presented for patients aligning with an hCG drug.

GnRH Analogs (Agonists or Antagonists).

 Gonadotropin-releasing hormone (GnRH) is a type of hormone that is produced in the brain at the hypothalamus. This drug works to stimulate the pituitary gland to make it form LH and FSH. GnRH is based on synthetic drugs which are considered either antagonists or agonists. They have similarities with the natural GnRH but work differently. Although the natural GnRH stimulates both LH and FSH, the analogs  prevent them from surge that happens exactly prior to ovulation. This prevents the releasing eggs prematuraly before they can be harvested for helping the reproductive technologies.

Figure 5

•GnRH agonists include leuprolide (Lupron, generic), nafarelin (Synarel), and goserelin (Zoladex).

•           GnRH antagonists include ganarelix (Antagon) and cetrorelix (Cetrotide).

 GnRH antagonists suppress FSH and LH more than GnRH agonists. Perhaps they need fewer injections.

Figure 6

Complications of Superovulation

Multiple Births:

The follicle overproduction may cause enlargement of the ovarian and this raises the multiple births with a percentage of 25%.  

Ovarian Hyperstimulation Syndrome:

The Ovarian Hyperstimulation Syndrome is considered the most serious complication related to superovulation as it is associated with having enlarged ovary and there is not any known cause for this. This then can lead to having dangerous fluid as well as electrolyte imbalances that may cause damage to liver and can cause damage to kidneys. It is also associated with other symptoms such as high pressure of blood, breathe shortness, nausea, vomiting and abnormal bloating which can endanger the life of the patient.

Bleeding and Rupture of Ovarian Cysts.

If the follicles overproduction is not checked, there could be rapture of ovarian cysts and bleeding. This shows that there is a possibility that clomiphene and gonadotropins can raise the breast and ovarian cancer risks. There isn't clear evidence for that but some studies suggest the relationship between the drug and breast cancer. Other studies suggest that it may reduce the risk for cancer in fact.

Other Drugs Used or Under Investigation

Letrozole and Aromatase Inhibitors.

 

Letrozole (AKA Femara)

Chemical Name: 4,4′-((1H-1,2,4-triazol-1-yl)methylene)dibenzonitrile

Molecular Weight: 285.303 g/mol

Formula: C17H11N5

Original Manufacturer: Novartis

Half Life: 2 – 4 days

Detection Time: 2 weeks

Anabolic Rating: N/A

Androgenic Rating: N/A

Aromatase is blocked by the aromatase inhibitors as the aromatase is an enzyme that is mainly responsible for estrogen production in the tissues of the women bodies outside of their ovaries. These drugs can include some main components such as letrozole (Femara) and anastrozole (Arimidex). Inspite of the fact that letrozole is not agreed as an infertility treatment, it is ususally used in theis purpose in the past few years.

Progesterone.

Progesterone is mainly a hormone that the human body produces in the menstrual cycle. They are given to the women who have suffered miscarriages. The miscarriages are signs of deficiency in the progesterone as the drug of it can be presented to the woman after her retrieval of eggs in the period of in vitro fertilization in order to make the uterine lining thicker and help it be more able to be ready for holding the egg in the next implantation.

Tamoxifen.

Tamoxifen (Nolvadex, generic) is a type of drug referred to also as a selective estrogen-receptor modulator (SERM). It is used for treating or preventing diseases like breast cancer in some specific cases of women. It has been examined in fertility treatments for ovulation inducing. Tamoxifen works in a way that resembles the work of clomiphene but it is different as it may lead to more health hazards with the risk for uterine cancer and blood clots. (Jordan et al, 2016)

Glucocorticoids.

Glucocorticoids drugs are steroid hormones mainly used associated with IVF and intracytoplasmic sperm injection (ICSI) for helping them make the uterus lining more responding to the implantation of the egg. Yet there are other reviews made recently that say that glucocorticoids do is not effective in improving the success of pregnancy and its rates and there is no need for using them routinely with assisted reproductive technologies. (Melo et al, 2015)

Figure 7 fertilization and implantation

Lifestyle Changes

There is not a specific diet that women should follow in order to have good levels of fertility but there are some basic lines for a healthy life style that should be followed to avoid infertility based on passive life styles and these are some tips:

• Keep a reasonable  healthy weight: Women who are not following rules to keep having healthy weight may be overweight or underweight and this makes them at risk for fertility problems, such as having lower opportunities to succeed in fertility procedures.
• Don't smoke:  Smoking can raise the infertility risk in both males and females so it is good to avoid smoking that is active or passive.
• Avoid extra exhausting sporting exercise if it hurts the menstrual cycle. Yet it is important to practice some simple and regular exercise such as aerobe or walking.
• Reduce the usage of caffeine and alcohol.
• Don't take any unneeded medications. (Nazni, 2014)

The role of pharmacist in dispensing these drugs (advices to the patients)

Patients who suffer infertility can be advised by the pharmacist about their cases through educating them about many channels such as the information found on media channels as TV and the internet. There are different online surveys and consulting services for infertility but the patients shouldn't investigate and deal with these sites all unless they are well known scientifically by a pharmacist, written by a special person or health organization and they have to be evidence based and peer reviewed. They may be misleading and inaccurate if found online in different sites that may not be educational or scientific. Systematic reviews can be effective and useful, they are advised to read them and make use of the information in them. Patients are also advised to consult doctors early as they have to consult doctors if they feel problems in the menstrual period or in being pregnant or even if they are women who are over 35 and still not pregnant. Pregnancy tests are essential to be made by patients regularly. There is a great role for the pharmacist in dispensing these drugs and managing the infertility in patients as he has to put great attention to the relevant details to the treatment regimens of infertility and advises the patients to do so. A pharmacist can also can be a good source for information of infertility patients, he can tell them about the reliable online sites for information and can also educate them and give them the medication counseling in things and issues such as training on techniques for injection and managing any relevant diverse effects. The pharmacist can also provide patients with assistance with financial considerations related to treatment of infertility and tests needed such as copay savings or prior authorization relevant to the different costs of infertility therapy.  (Barnes and Wiemer, 2015).            

Conclusion

In conclusion, infertility is a case of inability to give birth or be pregnant for longer than a year after regular sexual contact. it is important to focus on the important of fertility and discovering infertility and its reasons early as this helps women treat it effectively and avoid many other relevant health problems. There are many signs and symptoms that can tell the patient should ask a doctor about fertility levels and if the patient suffers infertility and what treatment should be applied with each patient such as the older age than 35 or the irregular menstrual cycle. There are many types of infertility and the doctor can decide this via different measurements and testing. There are many associating risk factors for infertility such as age, weight, smoking and others. The patient can receive different types of treatment and medicines based on the needs and the success of the treatment received by the patient. It is necessary to follow a healthy life style in order to avoid infertility that is related to some bad habits such as smoking or taking too much caffeine or alcohol.

 

References

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https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/polycystic-ovary-syndrome-pcos