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Published byKathleen Churchwell Modified over 9 years ago
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Jisha Rajendran
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Keay SD et al. BJOG. 1997
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14 70 FSH 70 14 True reserve – only after stimulation
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Individualise the protocol Early initiation of treatment Counsel against stimulation
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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
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Modify Stimulation Protocol Adjuvant therapy Mini dose protocol “Stop” protocol Short/ Ultra-short/Flare protocol Micro dose flare protocol
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Modify Stimulation Protocol
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Adjuvant therapy Growth Hormone Androgens Soft Protocols r- LH L-arginine, steroids, aspirin COC pill Estradiol
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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
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Androgens DHES
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r- LH
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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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