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Jisha Rajendran Keay SD et al. BJOG. 1997.

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Presentation on theme: "Jisha Rajendran Keay SD et al. BJOG. 1997."— Presentation transcript:

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2 Jisha Rajendran

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4 Keay SD et al. BJOG. 1997

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7 14 70 FSH True reserve – only after stimulation

8 Individualise the protocol Early initiation of treatment Counsel against stimulation

9 hormones Dynamic tests ultrasound FSH Most commonly used Easily available D2 or D3 higher values –predictive False positive rate 5% SCREENING TEST! 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 ultrasound 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 AFC Simple test Good inter- & intra- observer reproducibility Before starting stimulation Better correlation with retrieval number Current role – widely practised

10 Modify Stimulation Protocol Adjuvant therapy Mini dose protocol “Stop” protocol Short/ Ultra-short/Flare protocol Micro dose flare protocol

11 Modify Stimulation Protocol

12 Adjuvant therapy Growth Hormone Androgens Soft Protocols r- LH L-arginine, steroids, aspirin COC pill Estradiol

13 Growth Hormone Case – Control design 128 – 81 2U s/c Growth Hormone More M-II oocytes, higher E2 levels, pregnancy rates Case – Control design 128 – 81 2U s/c Growth Hormone More M-II oocytes, higher E2 levels, pregnancy rates

14 Androgens DHES

15 r- LH

16 1.Not uncommon 2.Bologna criteria – Age, risk factors, ORT, previous cycle response 3.Hormones + USG – better prediction 4.Modified protocols 5.Adjuvants


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