GnRH antagonists

kasr al ainy school of Medicine Cairo University CHANGING ATTITUDES IN OVARIAN STIMULATION

CHANGING ATTITUDE IS A FACT OF LIFE ,[object Object],[object Object]

THE BEST MODEL ,[object Object]

WHAT ABOUT GYNECOLOGY ,[object Object]

16 follicles 12 mature oocytes 14 oocytes Extras frozen if good 2 to 3 transferred 9 fertilize normally 5 divide normally 30-40% of couples 4 stop dividing & sperm Typical progression

OHSS is the most serious complication of ovulation induction.

PROTOCOLS FOR IVF GnRH Antagonist Protocols GnRH Agonist Protocols 225 IU per day (150 IU Europe ) Individualized Dosing of FSH/HMG 250 mg per day antagonist Individualized Dosing of FSH/HMG GnRHa 1.0 mg per day up to 21 days 0.5 mg per day of GnRHa 225 IU per day (150 IU Europe ) Day 6 of FSH/HMG Day of hCG Day 1 of FSH/HMG Day 6 of FSH/HMG Day of hCG 7 – 8 days after estimated ovulation Down regulation Day 2 or 3 of menses Day 1 FSH/HMG

SHOULD BE EVIDENCE BASED ,[object Object],[object Object]

AL-INANY ET AL., 2006 ,[object Object]

AL-INANY ET AL., 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IT IS JUSTIFIED TO ,[object Object]

HOW TO EXPLAIN ,[object Object],[object Object],[object Object],[object Object],[object Object]

NUMBER NEEDED TO HARM ,[object Object],[object Object]

CONSIDERING CYCLES CANCELLED FOR RISK OF OHSS ,[object Object],[object Object]

IN FAVOR OF ANTAGONIST ,[object Object],[object Object],[object Object]

3. 0 ampoules less with GnRH antagonists p<0.0 7 FSH requirement

1. 1 less days with antagonists p<0.001 Duration of FSH treatment

HOW TO EXPLAIN IMPROVED EFFICACY ,[object Object]

LH STABILITY: AGONIST VS. ANATGONIST

Flexible antagonist stimulation

Meta-analysis of clinical pregnancy rate in fixed and flexible protocols for GnRH antagonist protocols Al-Inany et al. 2005

FURTHER ANALYSIS ,[object Object],[object Object],[object Object],[object Object]

SO OUR CONCLUSION: ,[object Object]

BUT NOT ALL DOCTORS WOULD GO FOR ANTAGONIST

(GNRH) ANTAGONISTS: OFF LABEL INDICATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

OUR RESULTS Parameter Coasting (n = 96) Antagonist (n = 94) P-value Age (years) 30.0 ± 4.9 29.6 ± 4.6 NS Duration of infertility (years) 6.64 ± 4.45 7.07 ± 4.3 NS No. of HMG injections 30.52 ± 8.9 29.94 ± 8.8 NS Days of stimulation 1 9.1 ± 1.5 9.4 ± 1.5 NS Peak oestradiol (pg/ml) 5087 ± 1589 5305 ± 1680 NS Oestradiol on day of HCG (pg/ml) 2605 ± 790 2721 ± 699 NS Range of oestradiol on day of HCG (pg/ml) 1110–4136 1223–4093 NS Day of intervention 2.82 ± 0.97 1.74 ± 0.91 <0.0001 No. of oocytes 14.06 ± 5.20 16.5 ± 7.60 0.02 No. of MII oocytes 11.13 ± 4.60 13.14 ± 6.60 NS No. of fertilized oocytes 7.97 ± 3.80 9.14 ± 4.70 NS No. of high quality embryos 2.21 ± 1.10 2.87 ± 1.20 0.0001 No. of embryos transferred 2.83 ± 0.50 2.79 ± 0.40 NS No. of cryopreserved embryos 4.50 ± 3.93 5.77 ± 4.87 NS Clinical pregnancy (%) 46/96 (47.9) 52/94 (55.3) NS Multiple pregnancy (%) 15/46 (32.6) 17/52 (32.7) NS

THE FUTURE ,[object Object],[object Object]

JUST A QUESTION ,[object Object]

WHY CHANGING ATTITUDE ,[object Object],[object Object]

THANK YOU Dr. Hesham Al-Inany MD, PhD e-mail : hesham@khosoba.com

GnRH antagonists

GnRH antagonists

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