Protocol for Infertility

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pres.layout = "LAYOUT_16x9";
pres.title = "Fertility: Western & Eastern Medicine — An Integrated Approach";
pres.author = "Orris Medical";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
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  western: "1B3A6B",   // richer navy (Western section bg)
  integrate:"2D4A3E",  // forest green (integration section bg)
  gray:    "A8B8C8",
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// ─── HELPERS ──────────────────────────────────────────────────────────────────
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// ─── SLIDE 1 — TITLE ─────────────────────────────────────────────────────────
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  s.addText("FERTILITY", {
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  s.addText("An Integrated Approach to Understanding and Treating Infertility", {
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    { text: "Definition  •  Diagnosis  •  Treatment  •  Complementary Medicine  •  Integration", options: {} }
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  s.addText("Based on Goldman-Cecil Medicine | Berek & Novak's Gynecology | WHO Guidelines | PubMed Evidence", {
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// ─── SLIDE 2 — WHAT IS INFERTILITY ──────────────────────────────────────────
{
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  sectionHeader(s, "OVERVIEW", C.teal);

  slideTitle(s, "What is Infertility?");
  divider(s, 0.9, C.gold);

  // WHO box
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  s.addText([
    { text: "WHO Definition:  ", options: { bold: true, color: C.gold } },
    { text: '"Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse."', options: { italic: true, color: C.blush } }
  ], { x: 0.7, y: 1.15, w: 8.6, h: 0.8, fontSize: 13 });

  // stat cards
  const cards = [
    { icon: "10–15%", label: "of couples\naffected worldwide" },
    { icon: "40%",    label: "cases due to\nmale factors" },
    { icon: "1/3",    label: "cases have\nmultiple causes" },
    { icon: "25 yrs", label: "peak female\nfertility age" },
  ];
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  s.addText("When to evaluate: Age <35 → after 12 months  |  Age ≥35 → after 6 months  |  Known risk factors → immediately", {
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  s.addText("Requirements for pregnancy: Adequate normal motile sperm → Patent ductal system → Unobstructed female tract → Ovulation → Fertilisation → Implantation in receptive endometrium", {
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// ─── SLIDE 3 — CAUSES OF INFERTILITY ────────────────────────────────────────
{
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  sectionHeader(s, "WESTERN MEDICINE — AETIOLOGY", C.western.replace("1B3A6B","2255AA"));

  slideTitle(s, "Causes of Infertility");
  divider(s, 0.9, C.gold);

  // Male column
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  s.addText("♂  Male Factors  (~40%)", { x: 0.3, y: 1.05, w: 4.3, h: 0.45, fontSize: 14, bold: true, color: C.gold, align: "center" });
  s.addText([
    { text: "• Decreased sperm production", options: { bullet: false, breakLine: true } },
    { text: "  (varicocele, testicular failure, cryptorchidism)", options: { italic: true, breakLine: true, color: C.gray } },
    { text: "• Ductal obstruction / post-vasectomy", options: { breakLine: true } },
    { text: "• Ejaculatory disorders / hypospadias", options: { breakLine: true } },
    { text: "• Abnormal semen: volume, motility, morphology", options: { breakLine: true } },
    { text: "• Immunologic (sperm antibodies)", options: { breakLine: true } },
    { text: "• Stress, smoking, drugs, caffeine", options: { breakLine: true } },
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  // Female column
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  s.addText("♀  Female Factors  (~60%)", { x: 5.0, y: 1.05, w: 4.7, h: 0.45, fontSize: 14, bold: true, color: C.teal, align: "center" });
  s.addText([
    { text: "• Tubal / pelvic disease (20–30%)", options: { breakLine: true } },
    { text: "  (PID, endometriosis, adhesions)", options: { italic: true, breakLine: true, color: C.gray } },
    { text: "• Anovulation / amenorrhoea (15%)", options: { breakLine: true } },
    { text: "• Uterine / cervical factors (10%)", options: { breakLine: true } },
    { text: "  (fibroids, polyps, Asherman syndrome)", options: { italic: true, breakLine: true, color: C.gray } },
    { text: "• Thyroid / metabolic disorders (5%)", options: { breakLine: true } },
    { text: "• Immunologic (5%)", options: { breakLine: true } },
    { text: "• Unexplained (<10%)", options: { breakLine: true } },
  ], { x: 5.15, y: 1.55, w: 4.35, h: 2.8, fontSize: 11, color: C.blush });

  s.addText("⚡  In ~1/3 of couples, more than one cause contributes", {
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}

// ─── SLIDE 4 — WESTERN DIAGNOSIS ────────────────────────────────────────────
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  sectionHeader(s, "WESTERN MEDICINE — DIAGNOSIS", C.gold);

  slideTitle(s, "Diagnostic Protocol");
  divider(s, 0.9, C.gold);

  const steps = [
    { num: "01", title: "History & Exam", body: "Both partners — together & separately\nMenstrual hx, surgical hx, STI hx, medications,\ntoxin/substance exposure, BMI, thyroid exam" },
    { num: "02", title: "Semen Analysis", body: "Volume, concentration, motility, morphology\n(WHO criteria) — cornerstone of male evaluation\nIf abnormal: FSH, LH, testosterone, prolactin" },
    { num: "03", title: "Female Hormones", body: "Day 2–3: FSH, LH, oestradiol, AMH (ovarian reserve)\nTSH, prolactin\nMid-luteal progesterone (day 21) for ovulation" },
    { num: "04", title: "Uterine / Tubal", body: "Hysterosalpingography (HSG) or sonohysterography\nDiagnostic laparoscopy if all prior tests normal\n(reveals endometriosis/tubal disease in 30–50%)" },
  ];

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// ─── SLIDE 5 — WESTERN TREATMENT ────────────────────────────────────────────
{
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  sectionHeader(s, "WESTERN MEDICINE — TREATMENT", C.gold);

  slideTitle(s, "Treatment by Cause");
  divider(s, 0.9, C.gold);

  // Ovulation induction
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  s.addText("STEP-UP OVULATION INDUCTION (Anovulation / PCOS)", {
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  const oi = [
    { step: "Step 1", drug: "Clomiphene Citrate", detail: "50–250 mg/day × 5d (cycle day 3–5)\nLetrozole equivalent — fewer multiples" },
    { step: "Step 2", drug: "Gonadotropins + hCG", detail: "FSH/hMG 75–300 IU/day SC × 5–12d\nMonitor by USS + oestradiol; trigger with hCG" },
    { step: "Step 3", drug: "IVF / ART", detail: "Failed induction, tubal disease,\nsevere male factor, advanced age" },
  ];
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  // other causes table
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  const rows = [
    ["Cause", "Treatment"],
    ["Hyperprolactinaemia", "Cabergoline 0.25mg 2×/wk (preferred) or Bromocriptine"],
    ["Tubal disease", "Surgical repair or IVF (often preferred)"],
    ["Endometriosis", "Surgical excision (mild) or IVF (moderate–severe)"],
    ["Uterine polyps/fibroids", "Hysteroscopic resection"],
    ["Severe male factor", "IVF + ICSI"],
  ];

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// ─── SLIDE 6 — ART ───────────────────────────────────────────────────────────
{
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  s.background = { color: C.deep };
  sectionHeader(s, "WESTERN MEDICINE — ASSISTED REPRODUCTIVE TECHNOLOGY", C.gold);

  slideTitle(s, "Assisted Reproductive Technologies (ART)");
  divider(s, 0.9, C.gold);

  const arts = [
    { abbr: "IUI", name: "Intrauterine Insemination", ind: "Mild male factor, cervical factor, unexplained infertility", rate: "10–20% per cycle" },
    { abbr: "IVF", name: "In Vitro Fertilisation", ind: "Tubal disease, failed ovulation induction, advanced age", rate: "30–50% per cycle (age-dependent)" },
    { abbr: "ICSI", name: "Intracytoplasmic Sperm Injection", ind: "Severe oligospermia / azoospermia, prior IVF fertilisation failure", rate: "Similar to IVF" },
    { abbr: "PGT", name: "Preimplantation Genetic Testing", ind: "Recurrent miscarriage, known genetic disorders, aneuploidy screening", rate: "Reduces miscarriage risk" },
    { abbr: "OD", name: "Donor Oocytes", ind: "Premature ovarian insufficiency, advanced age, poor reserve", rate: "50–60% per transfer" },
  ];

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    s.addText(a.ind, { x: 1.6, y: y + 0.32, w: 5.3, h: 0.28, fontSize: 9.5, color: C.blush });
    s.addText("~" + a.rate, { x: 7.0, y: y + 0.1, w: 2.5, h: 0.45, fontSize: 10, color: C.teal, align: "right", italic: true });
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}

// ─── SLIDE 7 — EASTERN OVERVIEW ──────────────────────────────────────────────
{
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  s.background = { color: C.eastern };
  sectionHeader(s, "EASTERN MEDICINE — TRADITIONAL CHINESE MEDICINE (TCM)", C.teal);

  slideTitle(s, "TCM Framework for Fertility");
  s.addText("Holistic medicine viewing the body as an interconnected energy system", {
    x: 0.5, y: 0.92, w: 9, h: 0.35, fontSize: 13, color: C.light, italic: true
  });
  divider(s, 1.3, C.gold);

  // Core pillars
  const pillars = [
    { title: "Qi (氣)", body: "Vital energy flowing through\nmeridians. Deficient Kidney Qi\nor Liver Qi stagnation are key\ncauses of infertility in TCM." },
    { title: "Blood (血)", body: "Nourishes the uterus; Blood\ndeficiency or stasis impairs\nendometrial lining and\nimplantation." },
    { title: "Jing (精)", body: "Essence — stored in Kidneys;\ngovernss reproductive capacity.\nDeclines with age; key target\nfor fertility treatment." },
    { title: "Shen (神)", body: "Mind/Spirit — stress and\nemotional imbalance disrupt\nthe Heart-Kidney axis and\nimpair reproductive function." },
  ];

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    s.addText(p.body, { x: x + 0.1, y: 2.0, w: 1.95, h: 1.55, fontSize: 10, color: C.light });
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  s.addText([
    { text: "TCM Diagnosis Tools:  ", options: { bold: true, color: C.gold } },
    { text: "Tongue inspection  •  Pulse reading (28 pulse qualities)  •  Pattern differentiation  •  Abdominal palpation  •  Detailed symptom history", options: { color: C.light } }
  ], { x: 0.5, y: 3.9, w: 9.0, h: 0.65, fontSize: 11 });

  s.addText("Common TCM Diagnoses: Kidney Yang deficiency  •  Kidney Yin deficiency  •  Liver Qi stagnation  •  Blood stasis  •  Phlegm-dampness  •  Heart-Spleen deficiency", {
    x: 0.3, y: 4.75, w: 9.4, h: 0.55, fontSize: 10.5, color: C.gray, italic: true, align: "center"
  });
}

// ─── SLIDE 8 — EASTERN TREATMENT ─────────────────────────────────────────────
{
  const s = addSlide();
  s.background = { color: C.eastern };
  sectionHeader(s, "EASTERN MEDICINE — TREATMENT MODALITIES", C.teal);

  slideTitle(s, "TCM Treatment Modalities");
  divider(s, 0.9, C.gold);

  const mods = [
    {
      name: "Acupuncture",
      icon: "⊕",
      points: [
        "Stimulates specific meridian points",
        "Improves uterine & ovarian blood flow",
        "Modulates HPO axis neuroendocrine signals",
        "Reduces cortisol / sympathetic tone",
        "Used periconception & around embryo transfer in IVF",
      ]
    },
    {
      name: "Chinese Herbal Medicine",
      icon: "❧",
      points: [
        "Individualised herbal prescriptions",
        "Kidney tonics: He Shou Wu, Shu Di Huang",
        "Blood movers: Dan Shen, Chi Shao",
        "Warm uterus: Ai Ye (Mugwort), Rou Gui",
        "Cycle-phase prescribing aligned to hormones",
      ]
    },
    {
      name: "Moxibustion",
      icon: "♨",
      points: [
        "Heat therapy using burning Artemisia",
        "Applied to Ren & Du meridian points",
        "Shen Que (CV8) for ovarian response",
        "Warms Kidney Yang, dispels Cold-Uterus",
        "Recent RCT: improved embryo cleavage rates",
      ]
    },
  ];

  mods.forEach((m, i) => {
    const x = 0.3 + i * 3.25;
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    s.addText(m.icon + "  " + m.name, { x, y: 1.1, w: 3.1, h: 0.5, fontSize: 13, bold: true, color: C.gold, align: "center" });
    s.addText(m.points.map(p => "• " + p).join("\n"), {
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  s.addText("Additional modalities: Dietary therapy (Five Flavours)  •  Qigong / Tai Chi  •  Tuina massage  •  Mind-body counselling", {
    x: 0.5, y: 4.8, w: 9, h: 0.45, fontSize: 10.5, color: C.light, italic: true, align: "center"
  });
}

// ─── SLIDE 9 — ACUPUNCTURE EVIDENCE ──────────────────────────────────────────
{
  const s = addSlide();
  s.background = { color: C.eastern };
  sectionHeader(s, "EASTERN MEDICINE — CLINICAL EVIDENCE", C.gold);

  slideTitle(s, "Acupuncture: What Does the Evidence Show?");
  divider(s, 0.9, C.gold);

  // evidence cards
  const evCards = [
    { label: "PCOS / Anovulation", text: "Electroacupuncture induced regular ovulation in >1/3 of anovulatory PCOS women.\nAuricular acupuncture beneficial for oligomenorrhoea and luteal insufficiency." },
    { label: "IVF — Embryo Transfer", text: "Multiple RCTs show increased clinical pregnancy rates with acupuncture 25 min pre/post-ET.\nRates: 31–43% (acupuncture) vs 23–26% (control).\nMeta-analysis (7 trials, 1,366 women) supports improved live birth rates." },
    { label: "Endometrial Receptivity", text: "2025 overview of 10 SRs: combination acupuncture + IVF may improve pregnancy rates.\nCaveat: all SRs rated critically low quality (AMSTAR-2). High-quality RCTs needed.\n(Fan et al., Front Med, 2025 — PMID 40950975)" },
    { label: "Poor Ovarian Response", text: "2026 multicenter RCT (140 women, 9 hospitals):\n✓ Higher embryo cleavage rate (100% vs 87%, p<0.001)\n✓ Lower basal FSH post-treatment\n✗ No significant difference in oocytes retrieved or live birth rate.\n(Su et al., Front Endocrinol, 2026 — PMID 41837144)" },
  ];

  evCards.forEach((c, i) => {
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    const y = (i < 2) ? 1.1 : 3.1;
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    s.addText(c.text, { x: x + 0.15, y: y + 0.45, w: 4.2, h: 1.2, fontSize: 9.5, color: C.light });
  });

  s.addText("Safety: No increased miscarriage or congenital anomaly risk. Acupuncture appears safe throughout fertility treatment.", {
    x: 0.35, y: 5.0, w: 9.3, h: 0.38,
    fontSize: 10, color: C.gray, italic: true, align: "center"
  });
}

// ─── SLIDE 10 — COMPARISON ────────────────────────────────────────────────────
{
  const s = addSlide();
  s.background = { color: C.deep };
  sectionHeader(s, "COMPARISON", C.teal);

  slideTitle(s, "Western vs. Eastern Medicine at a Glance");
  divider(s, 0.9, C.gold);

  // headers
  s.addShape(pres.ShapeType.rect, { x: 2.8, y: 1.05, w: 3.2, h: 0.45, fill: { color: C.western }, line: { color: C.gold } });
  s.addText("WESTERN MEDICINE", { x: 2.8, y: 1.05, w: 3.2, h: 0.45, fontSize: 12, bold: true, color: C.gold, align: "center", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 6.2, y: 1.05, w: 3.5, h: 0.45, fill: { color: C.eastern }, line: { color: C.teal } });
  s.addText("EASTERN MEDICINE (TCM)", { x: 6.2, y: 1.05, w: 3.5, h: 0.45, fontSize: 12, bold: true, color: C.teal, align: "center", valign: "middle" });

  const rows2 = [
    ["Aspect", "Western Medicine", "TCM / Acupuncture"],
    ["View of disease", "Structural / biochemical defect", "Energetic imbalance, pattern disharmony"],
    ["Diagnosis", "Labs, imaging, semen analysis", "Tongue, pulse, symptom patterns"],
    ["Ovulation treatment", "Clomiphene, gonadotropins, IVF", "Acupuncture, herbal tonics, moxibustion"],
    ["Tubal disease", "HSG, surgery, IVF", "Herbs for blood stasis, acupuncture"],
    ["Stress / psychological", "Rarely addressed directly", "Central; Heart-Kidney axis targeted"],
    ["Evidence base", "RCTs, meta-analyses, guidelines", "Growing; many low-quality studies"],
    ["Pregnancy rates", "40–50% (IVF, age-dependent)", "Adjunctive; 5–15% additive benefit"],
    ["Safety profile", "OHSS, multiple gestation risks", "Generally safe, minimal side effects"],
  ];

  s.addTable(rows2, {
    x: 0.3, y: 1.55, w: 9.4, h: 3.9,
    colW: [2.4, 3.2, 3.8],
    border: { pt: 0.4, color: C.mid },
    fill: C.deep,
    fontFace: "Calibri",
    fontSize: 9.5,
    color: C.blush,
    rowH: 0.42,
    autoPage: false,
    firstRowAsHeader: true,
  });
}

// ─── SLIDE 11 — INTEGRATION ────────────────────────────────────────────────────
{
  const s = addSlide();
  s.background = { color: C.integrate };
  sectionHeader(s, "INTEGRATED APPROACH", C.gold);

  slideTitle(s, "Integrating Western & Eastern Medicine");
  s.addText("A complementary model — not either/or", {
    x: 0.5, y: 0.9, w: 7, h: 0.35, fontSize: 13, color: C.light, italic: true
  });
  divider(s, 1.3, C.gold);

  // phases
  const phases = [
    {
      phase: "Phase 1\nInvestigation",
      west: "Full infertility workup:\nSemen analysis, AMH, FSH,\nHSG / laparoscopy",
      east: "TCM pattern diagnosis:\nTongue, pulse, lifestyle history\nIdentify root pattern (Kidney, Liver, Blood)"
    },
    {
      phase: "Phase 2\nPreparation\n(3–6 months)",
      west: "Optimise BMI, thyroid, glucose\nFolic acid 400–800 mcg/day\nSmoking / alcohol cessation",
      east: "Acupuncture weekly (cycle-phased)\nHerbal medicine for pattern\nQigong / stress reduction"
    },
    {
      phase: "Phase 3\nActive Treatment",
      west: "Ovulation induction:\nClomiphene → Gonadotropins → IVF\nSurgical correction if indicated",
      east: "Continue acupuncture alongside\nIUI / IVF cycles\nPre/post embryo transfer sessions"
    },
    {
      phase: "Phase 4\nPost-Transfer /\nEarly Pregnancy",
      west: "Luteal phase progesterone support\nBeta-hCG monitoring\nEarly ultrasound",
      east: "Acupuncture for implantation support\nCalming herbs (where safe)\nMind-body therapy"
    },
  ];

  phases.forEach((p, i) => {
    const y = 1.45 + i * 1.0;
    // phase label
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 1.7, h: 0.8, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.06 });
    s.addText(p.phase, { x: 0.3, y, w: 1.7, h: 0.8, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle" });
    // west
    s.addShape(pres.ShapeType.rect, { x: 2.15, y, w: 3.7, h: 0.8, fill: { color: "1B3A6B" }, line: { color: C.gold } });
    s.addText(p.west, { x: 2.25, y: y + 0.05, w: 3.5, h: 0.7, fontSize: 9.5, color: C.blush });
    // east
    s.addShape(pres.ShapeType.rect, { x: 6.0, y, w: 3.7, h: 0.8, fill: { color: C.eastern }, line: { color: C.teal } });
    s.addText(p.east, { x: 6.1, y: y + 0.05, w: 3.5, h: 0.7, fontSize: 9.5, color: C.light });
  });

  // column headers
  s.addText("Western", { x: 2.15, y: 1.32, w: 3.7, h: 0.22, fontSize: 10, bold: true, color: C.gold, align: "center" });
  s.addText("Eastern / TCM", { x: 6.0, y: 1.32, w: 3.7, h: 0.22, fontSize: 10, bold: true, color: C.teal, align: "center" });
}

// ─── SLIDE 12 — CLINICAL INTEGRATION PROTOCOL ───────────────────────────────
{
  const s = addSlide();
  s.background = { color: C.integrate };
  sectionHeader(s, "INTEGRATED APPROACH — PRACTICAL PROTOCOL", C.gold);

  slideTitle(s, "Practical Integration: Evidence-Based Recommendations");
  divider(s, 0.9, C.gold);

  const recs = [
    { icon: "✓", text: "Recommend acupuncture as an adjunct to IVF — particularly 25 min pre/post-embryo transfer", strength: "Moderate evidence" },
    { icon: "✓", text: "Offer mind-body therapy (CBT, relaxation, hypnosis) to all patients undergoing ART — improves wellbeing and may improve pregnancy rates", strength: "Moderate evidence" },
    { icon: "✓", text: "Screen for and treat hypothyroidism and hyperprolactinaemia — often improved by both medical Rx and TCM herbal/acupuncture approaches", strength: "Strong evidence" },
    { icon: "✓", text: "Lifestyle optimisation (BMI, smoking cessation, stress reduction) is a shared cornerstone of both Western and Eastern approaches", strength: "Strong evidence" },
    { icon: "◎", text: "Chinese herbal medicine: individualise with caution; some herbs are teratogenic or interact with hormonal medications — always disclose to treating physician", strength: "Caution required" },
    { icon: "◎", text: "Do NOT delay evidence-based treatment (IVF, surgery) in favour of exclusive TCM — use as complementary, not alternative", strength: "Strong recommendation" },
    { icon: "◎", text: "Acupuncture for poor ovarian response: limited evidence — cleavage rates may improve, but live birth rates not yet significantly improved", strength: "Low evidence" },
  ];

  recs.forEach((r, i) => {
    const y = 1.05 + i * 0.64;
    const iconColor = r.icon === "✓" ? C.teal : C.gold;
    s.addText(r.icon, { x: 0.3, y, w: 0.4, h: 0.5, fontSize: 18, bold: true, color: iconColor, valign: "middle" });
    s.addText(r.text, { x: 0.75, y, w: 7.5, h: 0.5, fontSize: 10.5, color: C.blush, valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: 8.35, y: y + 0.08, w: 1.4, h: 0.34, fill: { color: r.icon === "✓" ? C.eastern : "4A3000" }, line: { color: iconColor }, rectRadius: 0.06 });
    s.addText(r.strength, { x: 8.35, y: y + 0.08, w: 1.4, h: 0.34, fontSize: 7.5, color: r.icon === "✓" ? C.light : C.gold, align: "center", valign: "middle" });
  });
}

// ─── SLIDE 13 — SUMMARY ──────────────────────────────────────────────────────
{
  const s = addSlide();
  s.background = { color: C.deep };
  sectionHeader(s, "SUMMARY", C.teal);

  slideTitle(s, "Key Takeaways");
  divider(s, 0.9, C.gold);

  const takes = [
    { num: "1", text: "Infertility affects >10% of couples. 40% male factor, ~60% female or combined. Evaluate after 12 months (<35 yrs) or 6 months (≥35 yrs)." },
    { num: "2", text: "Western medicine offers structured diagnosis (semen analysis, hormone panels, HSG, laparoscopy) and effective treatments (clomiphene, gonadotropins, IVF, ICSI)." },
    { num: "3", text: "TCM views infertility through energetic lens (Kidney Jing, Qi, Blood). Acupuncture, herbal medicine, and moxibustion target the root pattern." },
    { num: "4", text: "Acupuncture shows promising but inconsistent evidence in IVF outcomes. Best evidence supports periconception use around embryo transfer." },
    { num: "5", text: "Integration is optimal: use Western diagnostics and ART as the primary framework; add TCM modalities for stress reduction, cycle support, and wellbeing." },
    { num: "6", text: "Always disclose all treatments to the care team. Herbal medicine can interact with medications. TCM should complement, never replace, evidence-based care." },
  ];

  takes.forEach((t, i) => {
    const y = 1.05 + i * 0.74;
    s.addShape(pres.ShapeType.ellipse, { x: 0.3, y: y + 0.05, w: 0.45, h: 0.45, fill: { color: C.teal }, line: { color: C.teal } });
    s.addText(t.num, { x: 0.3, y: y + 0.05, w: 0.45, h: 0.45, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(t.text, { x: 0.9, y, w: 8.8, h: 0.65, fontSize: 10.5, color: C.blush, valign: "middle" });
  });
}

// ─── SLIDE 14 — REFERENCES ───────────────────────────────────────────────────
{
  const s = addSlide();
  s.background = { color: C.deep };
  sectionHeader(s, "REFERENCES", C.gray);

  s.addText("References & Further Reading", {
    x: 0.5, y: 0.3, w: 9, h: 0.6, fontSize: 22, bold: true, color: C.gold
  });
  divider(s, 0.95, C.teal);

  s.addText([
    { text: "Textbooks\n", options: { bold: true, color: C.teal, breakLine: true } },
    { text: "• Goldman, L. & Cooney, K.A. (2024). Goldman-Cecil Medicine, 27th ed. Elsevier. Chapter 218 (Infertility), pp. 2560–2562\n", options: { breakLine: true } },
    { text: "• Berek, J.S. (2019). Berek & Novak's Gynecology, 16th ed. Wolters Kluwer. Chapters on Infertility, Endometriosis & Complementary Medicine\n", options: { breakLine: true } },
    { text: "• Harrison's Principles of Internal Medicine, 22E (2025). McGraw-Hill Medical\n\n", options: { breakLine: true } },
    { text: "Clinical Evidence\n", options: { bold: true, color: C.teal, breakLine: true } },
    { text: "• Fan H et al. (2025). Acupuncture on endometrial receptivity — overview of SRs/MAs. Front Med. PMID: 40950975\n", options: { breakLine: true } },
    { text: "• Su C et al. (2026). Acupuncture for poor ovarian response: multicenter RCT. Front Endocrinol. PMID: 41837144\n", options: { breakLine: true } },
    { text: "• Conforti A et al. (2025). Therapeutic management in diminished ovarian reserve: SR/MA. Fertil Steril. PMID: 39332623\n\n", options: { breakLine: true } },
    { text: "Guidelines\n", options: { bold: true, color: C.teal, breakLine: true } },
    { text: "• WHO (2023). Infertility Prevalence Estimates, 1990–2021. World Health Organization.\n", options: { breakLine: true } },
    { text: "• ASRM Practice Guidelines. American Society for Reproductive Medicine. www.asrm.org", options: {} },
  ], {
    x: 0.5, y: 1.1, w: 9, h: 4.2,
    fontSize: 9.5, color: C.blush, fontFace: "Calibri"
  });
}

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/fertility-pptx/Fertility_Western_Eastern_Integrated.pptx" })
  .then(() => console.log("✅ Saved: Fertility_Western_Eastern_Integrated.pptx"))
  .catch(err => { console.error("❌ Error:", err); process.exit(1); });