GnRH AGONİST GnRH ANTAGONİST POOR RESPONDER BACKGROUND. This is the first published report of a prospective, randomized, controlled trial comparing a.

... konulu sunumlar: "GnRH AGONİST GnRH ANTAGONİST POOR RESPONDER BACKGROUND. This is the first published report of a prospective, randomized, controlled trial comparing a."— Sunum transkripti:

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2 GnRH AGONİST GnRH ANTAGONİST POOR RESPONDER

3 BACKGROUND. This is the first published report of a prospective, randomized, controlled trial comparing a fixed, multi-dose GnRH antagonist protocol with a long GnRH agonist protocol in poor responders undergoing IVF. 2005

4 the first published report

5 Human Reproduction Update, Vol.12, No.6 pp. 651–671, 2006 doi:10.1093/humupd/dml038 Advance Access publication August 18, 2006 Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used? A systematic review and meta-analysis E.M.Kolibianakis 1,5, J.Collins 2, B.C.Tarlatzis 1, P.Devroey 3, K.Diedrich 4 and G.Griesinger 4 Canlı Doğum Oranı

6 Meta-analysis of the number of oocytes retrieved with different pituitary suppression regimens in poor responders. Sunkara et al. Reproductive Health 2007 4:12 doi:10.1186/1742-4755-4-12

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10 STİMULASYON SÜRESİ

11 OOSİT SAYISI

12 SİKLUS İPTALİ

13 KLİNİK GEBELİK ORANI

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15 HANGİSİ İLE KARŞILAŞTIRILACAK? GnRH-analog uygulamaları -long protokol -short -ultrashort -minidoz -stop Lupron -mikrodoz + GH GnRH-antagonist uygulamaları -Fixed -Fleksible -Letrozol ile -GnRH-a flare ile -Luteal (CRASH) -E2 priming

16 İleri yaş(>40 yaş)veya POR risk faktörü varlığı -Daha önce POR hikayesi (Konvansiyonel protokolde oosit< 3 oosit) -Anormal over rezerv testleri (AFC < 5-7, AMH < 0.1-1.1) En az ikisi olmalı

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18 FLEKSİBLE ANTAGONİST SHORT AGONİSTTEN DAHA İYİ

19 (1)the GnRH-a long regimen, (2) the GnRH-a short regimen (3) the GnRH antagonist reg.

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21 GnRh-antagonist GnRh-a long Klinik gebelik açısından GnRh-antagonist GnRh-a long Klinik gebelik açısından

22 GnRh-antagonist GnRh-a flare-up Klinik gebelik açısından GnRh-antagonist GnRh-a flare-up Klinik gebelik açısından

23 Flex.GnR-antagonist GnRh-a minidoz Klinik gebelik açısından Flex.GnR-antagonist GnRh-a minidoz Klinik gebelik açısından

24 GnRh-a flare-up GnRh-a modifiye long Klinik gebelik açısından GnRh-a flare-up GnRh-a modifiye long Klinik gebelik açısından

25 A U T H O R S ’ C O N C L U S I O N S Implications for practice There is insufficient evidence to identify the use of any one particular intervention to improve treatment outcomes in poor responders in IVF. The results of this review should be balanced by a careful consideration of the small number of trials, small number of participants and the heterogeneity between the trials. Given the cost of the treatments and the lack of good evidence, it would seem reasonable to say that these A U T H O R S ’ C O N C L U S I O N S Implications for practice There is insufficient evidence to identify the use of any one particular intervention to improve treatment outcomes in poor responders in IVF. The results of this review should be balanced by a careful consideration of the small number of trials, small number of participants and the heterogeneity between the trials. Given the cost of the treatments and the lack of good evidence, it would seem reasonable to say that these

26 GnRH-a ile GnRH-ant. karşılaştırmak için kaç vaka gerekiyor? Klinik gebelik oranındaki % 5 lik farkı ortaya koymak için % 25 lik beklenen bir gebelik oranında,β-hata 0.2 ve α-hata 0.05 kabul edilldiğinde Her iki grup için 1252 olmak üzere toplam 2504 hasta gerekir

27 Antagonist poor responder AKLIMIZDA NE KALDI ? AKLIMIZDA NE KALDI ?

28 Antagonistler kötü over yanıtlı hastalarda bir alternatiftir Kötü over yanıtlı hastalarda GnRH antagonist/ agonist karşılaştırmaları net bir mesaj verememektedir. Randomizasyonu ve metodolojisi iyi planlanmuş çalışmalara ihtiyaç vardır

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