treatment protocols for hyperresponders in art
TRANSCRIPT
08.03.2016
1
IVF- hyperresponders
Dr. Tevfik Yoldemir
Marmara Üniversitesi Kadın Hastalıkları ve Doğum A.D.
Foliküllerin seyri
Human Reproduction Update, Vol.15, No.1 pp. 13–29, 2009
FSH penceresi
Human Reproduction Update, Vol.15, No.1 pp. 13–29, 2009
Oosit ve embryo –
konvansiyonel vs mild
Human Reproduction Update, Vol.15, No.1 pp. 13–29, 2009
Over rezerv parametreleri
European Journal of Obstetrics & Gynecology
and Reproductive Biology 168 (2013) 173–177
AFS AMH – yüksek cevap
Human Reproduction Update, Vol.17, No.1 pp. 46–54, 2011
08.03.2016
2
Bireyselleştirilmiş tedavi
Human Reproduction Update, Vol.20, No.1 pp. 124–140, 2014
AMH cut-off değerleri – yuksek cevap
Human Reproduction Update, Vol.20, No.1 pp. 124–140, 2014
AFS cut-off değerleri – yüksek cevap
Human Reproduction Update, Vol.20, No.1 pp. 124–140, 2014
FSH başlangıç dozu –yaş, AFS,FSHD3
La Marca 2013
FSH başlangıç dozu –yaş, AMH,FSHD3
La Marca 2012
Yüksek AMH – Düşük AMH
.Fertility and Sterility® Vol. 102, No. 6, December 2014
5.2 μg, 6.9 μ g, 8.6 μg, 10.3 μ g, or 12.1 μg rhFSH (FE 999049; Ferring Pharmaceuticals),
11 μg (150 IU) follitropin alfa (Gonal-F filled by mass; Merck Serono).
08.03.2016
3
Yüksek AMH – Düşük AMH
Fertility and Sterility® Vol. 102, No. 6, December 2014
Yüksek AMH – Düşük AMH
Fertility and Sterility® Vol. 102, No. 6, December 2014
Yüksek AMH – Düşük AMH Over cevabı- gonadotropin tipi
Gynecol Endocrinol, 2014; 30(6): 444–450
Canlı doğum- gonadotropin tipi
Gynecol Endocrinol, 2014; 30(6): 444–450
Yuksek cevaplı- D3 ET vs Blast transfer
J Assist Reprod Genet (2014) 31:275–278
08.03.2016
4
Yuksek cevaplı- Blast transfer vs FET
J Assist Reprod Genet (2014) 31:275–278
Stimulasyon tahmini
Reproductive Biology and Endocrinology 2007, 5:9 doi:10.1186/1477-7827-5-9
Prognostik faktörler - GnRHAnta
Human Reproduction, Vol.29, No.8 pp. 1688–1697, 2014
Mild Anta vs Long Agon.
J Assist Reprod Genet (2012) 29:1343–1351
Mild – 150 IU CD4, GnRHanta CD8
Anta vs Agonist – iyi prognozlu hastalar
Reproductive BioMedicine Online (2014) 29, 299–304
Anta vs Agonist – iyi prognozlu hastalar
Reproductive BioMedicine Online (2014) 29, 299–304
08.03.2016
5
Anta vs Agonist – iyi prognozlu hastalar
Reproductive BioMedicine Online (2014) 29, 299–304
IVFde Yüksek cevap
Reproductive Biology and Endocrinology 2007, 5:9 doi:10.1186/1477-7827-5-9
GnRHanta trigger
Human Reproduction Update, Vol.17, No.4 pp. 510–524, 201120 / 200
Luteal destek – GnRH anta trigger
• Serum estradiol ve progesteron ET günü, OPUdan bir hafta sonra ve sonra haftalık.
• transdermal estradiol patch 3 adet 0.1 mg patchgünaşırı
• 4 cıkılabilir veya oral mikronize estradiol >> serum estradiol seviyesi >200 pg/ml.
• IM progesterone dozu da maximum 75 mg günlük ve/veya mikronize vaginal progesteron
• serum progesteron seviyesi >20 ng/ml.
Human Reproduction Update, Vol.17, No.4 pp. 510–524, 2011
Papanikolaou et al. Reproductive Biology and Endocrinology 2011, 9:147
Natural siklus IVF
Human Reproduction Update, Vol.15, No.1 pp. 13–29, 2009
08.03.2016
6
KS ile IVF
Human Reproduction Update, Vol.15, No.1 pp. 13–29, 2009
Geç başlangıçlı IVF
Human Reproduction Update, Vol.15, No.1 pp. 13–29, 2009
GnRH antagonist rescue
Reproductive BioMedicine Online (2012) 25, 284– 291
GnRH analog >> GnRH anta
GnRH antagonist rescue
Reproductive BioMedicine Online (2012) 25, 284– 291
GnRH antagonist rescue
Reproductive BioMedicine Online (2012) 25, 284– 291 Reproductive Biology and Endocrinology 2011, 9:85
08.03.2016
7
Progesteron yüksekliği taze ET
Gebelik - PE olanlar vs PE olmayanlar
Human Reproduction Update, Vol.19, No.5 pp. 433–457, 2013
Gebelik PE olanlar vs PE olmayanlar
Alt grup analizi
Human Reproduction Update, Vol.19, No.5 pp. 433–457, 2013
Gebelik - PE olanlar vs PE olmayanlar
Alt grup analizi
Human Reproduction Update, Vol.19, No.5 pp. 433–457, 2013
Gebelik - PE olanlar vs PE olmayanlar
Human Reproduction Update, Vol.19, No.5 pp. 433–457, 2013
Bireyselleştirilmiş AMH bazlı KOS
Nelson 2009 Yates 2011
Tedavi stratejisi
Human Reproduction Update, Vol.20, No.1 pp. 124–140, 2014
08.03.2016
8
Dikkatiniz için teşekkür ederim
Dr. Tevfik Yoldemir
http://www.slideshare.net/dryoldemir