Gonadotrpin ovarian stimulation: Aboubakr elnashar

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Gonadotrpin ovarian stimulation Aboubakr elnashar

Transcript of Gonadotrpin ovarian stimulation: Aboubakr elnashar

  • Gonadotrpin ovarian stimulation Aboubakr elnashar Benha university Hospital, EgyptAboubakr Elnashar
  • Contents Types of anovulation Types of ovarian stimulations Types of Gnt Patient selection Indications Contraindications Protocols Monitoring Results Complications Conclusion Aboubakr Elnashar
  • Anovulation % Type Hormonal profile 5-10% WHO type I (Hypogonadotropic Hypoestrogenic) E2 FSH 75-80% WHO type II Normogenadotrophic Normoestrogenic Normal E2 Normal FSH 10-20% WHO type III (Hypergonadotropic Hypoestrogenic) E2 FSH 5-10% WHO type IV (Hyperprolactinemia) prolactin WHO Scientific group, Geneva 1976, Report 514, Rowe et al, 1993 Aboubakr Elnashar
  • Types of ovarian stimulation Controlled ovarian stimulation Super ovulation Induction of ovulation Anovulatory or ovulatoryAnovulatoryPatient Multiple> oneOne mature follicle Objective IVFIUI Unexp inf Example Down regulation Stimulation Prevent premature LH surge StimulationStimulationMethod Aboubakr Elnashar
  • Gonadotropin Preparations 3 main preparations: FSH, LH & HCG 2 types I. Urinary 1. HMG 2. Highly purified HMG 3. Purified FSH 4. Highly purified FSH 5. Urinary HCG II. Recombinant 1. Rec FSH 2. Rec HCG 3. Rec LH Aboubakr Elnashar
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  • Preparation Trade name Route U.pr FSH LH Price Company HMG Pergonal, Humegon, Menogon, Merional IM 95% 75 75 Serono Organon Ibsa H.P.HMG Menopur SC 10 mm {predict the risk of multiple pregnancies}. 1 or 2 follicles 18-20 mm: HCG Daily SI on the day of HCG& for the next 2 days Aboubakr Elnashar
  • > 3 follicles > 16 mm: (Macklon et al, 1999). >4 follicles 14 mm (Kamrava et al., 1982; Hugues et al., 2006). Stop stimulation& hCG withheld Gnt follicles mature at 15-18 mm CC follicles mature at 18-20 mm (Sperof,f 2005) Aboubakr Elnashar
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  • b. Endometrial thickness: 90% Aboubakr Elnashar
  • II. Pregnancy Low: 1. hyperandrogenic chronic anovulation group 2. Above 35 y CC resistant anovulatory Hypogonadotropic hypogonadism 5-15%25%Cycle fecundity 30-60%90%Cumulative PR after up to 6 cycles Aboubakr Elnashar
  • III. Miscarriage 20-25% moderately higher than is generally (15%). 1. advanced maternal age 2. obesity Low in hypogonadotropic hypogonadism Higher in clomiphene-resistant anovulatory women Aboubakr Elnashar
  • IV. Congenital anomalies. No increase Aboubakr Elnashar
  • Complications I. Multiple pregnancy: Low dose protocol: