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Prof. Dr. Tayfun Bagis Acıbadem University. The 2 studies had different results for pregnancy outcomes *Live birth rate included ongoing pregnancies (Al-Inany)

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Presentation on theme: "Prof. Dr. Tayfun Bagis Acıbadem University. The 2 studies had different results for pregnancy outcomes *Live birth rate included ongoing pregnancies (Al-Inany)"— Presentation transcript:

1 Prof. Dr. Tayfun Bagis Acıbadem University

2 The 2 studies had different results for pregnancy outcomes *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. Al-Inany 1 Kolibianakis 2 OR0.820.86 95% CI0.69-0.980.72-1.02 P value0.030.085 Live Birth Rate* in Meta-analyses, GnRH Antagonists vs GnRH Agonists

3 3,1763,865Total patients Live birth rate* (All 22 studies included; in 12/22 studies, live births estimated) Ongoing pregnancy or live birth rate (Only 15 studies evaluable, n=2,973) Primary outcome 2227No. of studies included Dec 2005Feb 2006Last date searched Kolibianakis 2 Al-Inany 1 Characteristic NoYes Included non–peer- reviewed data *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. NoYesIncluded studies on IUI IUI = intrauterine insemination.

4 Al-Inany 1 Kolibianakis 2 Duration of analog treatment −20.90 days (95% CI −22.20, −19.60) −19.48 days (95% CI −21.05, −17.91) Duration of ovarian stimulation −1.54 days (95% CI −2.42, −0.66; P=0.0006) −1.13 days (95% CI −1.83, −0.44) Risk of severe OHSS OR 0.61 (95% CI –0.42, 0.89; P=0.01) RR 0.46* (95% CI 0.26, 0.82; P=0.01) Interventions to prevent OHSS OR 0.44 (95% CI 0.21, 0.93; P=0.03) *For every 59 women treated with a GnRH agonist vs GnRH 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 Kolibianakis 2 LH riseOR 8.27 (95% CI 3.82-17.90) LH surge OR 4.05 (95% CI 1.53-10.72) 2. Kolibianakis et al. Hum Reprod Update. 2006;12:651.

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

9 OCP pre-treatment Rate difference in ongoing pregnancy per woman: -5% (95% CI: -10 to -1), p = 0.02 1. Griesinger et al. Fertil Steril. 2008:90;1055-1063. 2. Update Griesinger et al. submitted

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18 Siklus başındaki problemler Gn ne zaman başlanmalı (2-3)? Korpus luteum rescue (P4 yüksekliği) D2 P4 ölçümü

19  Problems at the beginning of cycle. Cycle day 2 Transvaginal US + (if desired) hormonal profile

20  Kolibianakis 2004

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29 A N=102 MODA N=66 P Female age32.02±4.931.74±4.80.711 Duration of infertility (years)4.3±3.13.9±3.30.444 BMI (kg/m2)24.07±4.323.4±3.60.374 Gravida0.64±1.030.37±0.80.077 Cycle no1.63±0.901.92±1.290.102 Antral follicle count13.6±6.414.6±5.30.381 ACIBADEM EXPERIENCE

30 ANT N=20 MODA N=20 P Total gonadotrophin dose1829.7±7341661.2±4820.116 E2/HCG day1483.1±1319.91858.9±1452.50.140 P/HCG day0.68±0.330.84±0.460.032 Endometrium/HCG day10.9±2.0711.2±2.590.419 No. Follicle >10mm/HCG11.05±5.812.64±5.270.091

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32 AMODAP P/HCG day ≥ 1.2 % 6.8%16.40.108

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34 OR 1.409 CI %95 (0.728-2.726)

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

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40 1- At least one follicle measuring >14 mm 2- Estradiol levels >600 pg/ml 3- LH levels >10 IU/l

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42 Retrieved oocytes12.1 MII %75.8 Fertilization %58.7 ET number1.9 Cryo number2.4 Ongoing IR %26.5 Ongoing PR/Cycle39.7 Ongoing PR/Retri39.7 Ongoing PR/ET42.4

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

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46 E2 response (defined as posttreatment/pretreatment E2 ratio) Upper quartile Middle quartile Lower quartile P Oocyte yield15.2 (7.5)13.1 (7.9)11.8 (5.6)<0.01 CPR45.928.7250.01 LBR38.622.3200.02

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51 HCG günü problemler HCG günü antagonist? HCG kriterleri? HCG ertelenebilir mi? HCG günü P4?

52 PHASE III TRIALS LH rises (≥10 IU /L) with concomitant progesterone rises (>1 ng/mL) European trial1.5% North American trial1.5% European and Middle East trial 0.4% GnRH agonist control group (pooled data) 0.8%

53 Premature luteinization p≥1.2 ng/ml No Premature luteinization P<1.2 ng/ml P No of patients (%)31/81 (38.3%)50/81 (61.7%) CPR/ET 8/31 (25.8%)27/50 (54%)0.01 LBR12/87 (13.8%)41/128 (32%)0.007

54 Overall prevalence of premature luteinization was 18.2 %. (P>1.5 ng/ml)

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58 Luteal faz problemler Vaginal & IM Progesteron? GnRH agonist suplementasyonu?

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