1 / 16

… an intractable problem in infertility treatment….

… an intractable problem in infertility treatment…. … with no clear definition/consensus…. … has managed to dodge the advances in infertility treatment…. POOR RESPONDERS IN INFERTILITY TREATMENT. Jisha Rajendran . Poor responders – it is not uncommon!. Poor responders – how to diagnose.

shae
Download Presentation

… an intractable problem in infertility treatment….

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. … an intractable problem in infertility treatment…. … with no clear definition/consensus…. … has managed to dodge the advances in infertility treatment….

  2. POOR RESPONDERS IN INFERTILITY TREATMENT Jisha Rajendran

  3. Poor responders – it is not uncommon! Keay SD et al. BJOG. 1997

  4. Poor responders – how to diagnose E2 D2 FSH HMG AFC AMH OOCYTES FOLLICLES

  5. Poor responders – BOLOGNA criteria from ESHRE ADVANCED AGE>40/OTHER RISK FACTORS FOR POR ABNORMAL ORT PREVIOUS POR

  6. Poor responders – BEHIND THE SCENES 70 70 FSH 14 14 True reserve – only after stimulation

  7. Poor responders – Why should you know them? • Individualise the protocol • Early initiation of treatment • Counsel against stimulation

  8. Poor responders – how to sight them? FSH Most commonly used Easily available D2 or D3 higher values –predictive False positive rate 5% SCREENING TEST! AMH Costly test Not widely available Cycle independent Better predictive value Current role - controversial AMH Costly test Not widely available Cycle independent Better predictive value Current role - controversial AFC Simple test Good inter- & intra- observer reproducibility Before starting stimulation Better correlation with retrieval number Current role – widely practised • ultrasound

  9. Poor responders – how to manage them? Mini dose protocol Conventional Agonists protocol - Dampening of ovarian response to gonadotropin stimulation Adjuvant therapy Modify Stimulation Protocol “Stop” protocol Short/ Ultra-short/Flare protocol Micro dose flare protocol

  10. Poor responders – how to manage them? Antagonist protocol -decreases stimulation duration -fewer cancellations -lesser Gonadotropins Modify Stimulation Protocol

  11. Poor responders – how to manage them? Growth Hormone Estradiol Adjuvant therapy Androgens COC pill Soft Protocols r- LH L-arginine, steroids, aspirin

  12. Poor responders – how to manage them? Potentiates effect of FSH Previous poor responders have proven benefit Costly Not widely available No consensus on dose / route Growth Hormone Case – Control design 128 – 81 2U s/c Growth Hormone More M-II oocytes, higher E2 levels, pregnancy rates

  13. Poor responders – how to manage them? Essential prohormone in follicular steroidogenesis Improves the ovarian micromilieu Micronised DHES – 25mg TID X 4months Improves pregnancy rates and reduces miscarriage rates Androgens DHES

  14. Poor responders – how to manage them? • LH plays a role in follicular development • From D8, 75-150 IU • Beneficial in a subset of • a. age >35, • b. previous POR • c. Antagonist cycles • Improves pregnancy rates r- LH

  15. Poor responders – what to remember? • Not uncommon • Bologna criteria – Age, risk factors, ORT, previous cycle response • Hormones + USG – better prediction • Modified protocols • Adjuvants

More Related