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IVF’te GnRH Antagonistleri: Dikkat Edilmesi Gereken Konular

IVF’te GnRH Antagonistleri: Dikkat Edilmesi Gereken Konular. Prof. Dr. Tayfun Bagis Acıbadem University. Meta-analyses of GnRH Antagonists vs GnRH Agonists: Pregnancy Outcomes. The 2 studies had different results for pregnancy outcomes. Live Birth Rate* in Meta-analyses,

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IVF’te GnRH Antagonistleri: Dikkat Edilmesi Gereken Konular

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  1. IVF’teGnRH Antagonistleri: Dikkat Edilmesi Gereken Konular Prof. Dr. Tayfun Bagis Acıbadem University

  2. Meta-analyses of GnRH AntagonistsvsGnRH Agonists: Pregnancy Outcomes • The 2 studies had different results for pregnancy outcomes Live Birth Rate* in Meta-analyses, GnRH Antagonists vsGnRH Agonists *Live birth rate included ongoing pregnancies (Al-Inany) or calculated rates (Kolibianakis). OR = odds ratio. 1. Al-Inany et al.Cochrane Database Syst Rev. 2006;3:CD001750. 2. Kolibianakis et al.Hum Reprod Update. 2006;12:651.

  3. Differences in Study Design/Data Handling May Have Affected Results of Meta-analyses of GnRH Antagonists vsGnRH Agonists Characteristic Al-Inany1 Kolibianakis2 Last date searched Feb 2006 Dec 2005 No. of studies included 27 22 Included non–peer-reviewed data Yes No Included studies on IUI Yes No Total patients 3,865 3,176 Primary outcome Ongoing pregnancy or live birth rate (Only 15 studies evaluable, n=2,973) Live birth rate* (All 22 studies included;in 12/22 studies, live births estimated) IUI = intrauterine insemination. *Ongoing pregnancies were converted to live birth equivalents. Live births = 84% of number viable at week 7 or 92% of number viable at week 12 of gestation. 1. Al-Inany et al.Cochrane Database Syst Rev. 2006;3:CD001750. 2. Kolibianakis et al.Hum Reprod Update. 2006;12:651.

  4. Meta-analyses Confirm That GnRH Antagonists Have a Better Safety Profile vs GnRH Agonists *For every 59 women treated with a GnRH agonist vsGnRH antagonist, 1 additional case of severe OHSS will occur.RR = risk ratio. 1. Al-Inany et al.Cochrane Database Syst Rev. 2006;3:CD001750. 2. Kolibianakis et al.Hum Reprod Update. 2006;12:651.

  5. 2. Kolibianakis et al. Hum Reprod Update. 2006;12:651.

  6. Siklus öncesi problemler Senkronizasyon (oosit sayısı) Fleksibilite (hafta sonu plan) Progesteron OKS Estrogen

  7. Does the efficacy of GnRH antagonists change with contraceptive pill pre-treatment? OCP pre-treatment Rate difference in ongoing pregnancy per woman: -5% (95% CI: -10 to -1), p = 0.02 1. Griesinger et al. FertilSteril. 2008:90;1055-1063. 2. Update Griesinger et al. submitted

  8. Siklus başındaki problemler Gn ne zaman başlanmalı (2-3)? Korpusluteumrescue (P4 yüksekliği) D2 P4 ölçümü

  9. Problems at thebeginning of cycle. Cycle day 2 Transvaginal US + (if desired) hormonal profile

  10. Kolibianakis 2004

  11. ACIBADEM EXPERIENCE

  12. OR 1.409 CI %95 (0.728-2.726)

  13. Antagonist başlama problemleri SD 4? SD5? SD6? Fleksible? Siklus başından itibaren? Modifiye protokoller? Antagonist dozu?

  14. 1- At least one follicle measuring >14 mm 2-Estradiollevels >600 pg/ml 3-LH levels >10 IU/l

  15. The Ganirelix dose-finding study group. Hum Reprod. 1998.

  16. The Ganirelix dose-finding study group. Hum Reprod. 1998.

  17. E2 response (defined as posttreatment/pretreatment E2 ratio)

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