safer drug with similar live birth rates

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

6. 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

7. OHSS is the most serious complication of ovulation induction.

8. 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

10. AL-INANY & ABOULGHAR, 2001

14. WHY: (AL-INANY ET AL, 2010)

17. CANCELLATION FOR RISK OF OHSS

20. LIVE BIRTH RATE

21. CPR

22. MISCARRIAGE RATE

24. 3. 0 ampoules less with GnRH antagonists p<0.0 7 FSH requirement

25. 1. 1 less days with antagonists p<0.001 Duration of FSH treatment

27. LH STABILITY: AGONIST VS. ANATGONIST

28. FIXED DOSE PROTOCOL

29. Flexible antagonist stimulation

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

33. BUT NOT ALL DOCTORS WOULD GO FOR ANTAGONIST

37. 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

40. SIMPLE, SHORTER SAFER

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