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Репродуктивно здраве => Асистирани репродуктивни методи (инсеминация, ин витро) => Темата е започната от: Divna в Февруари 12, 2006, 09:30:55 am
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Момичета, променят ми стмулацията .Предните ми 2 опита бяха с Декапептил депо -реагирах доста бурно,та сега ще я правят с Оргалутран/незнам дори дали изписвам правилно/ с цел да избегнат хиперстимулация.Та ако някой има информация или опит моля да сподели. :)
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Дивна, това е част от статията публикувана във FERTILITY AND STERILITY, JANUARY 2004. "Luteolysis induced by a gonadotropinreleasing hormone agonist is the key to prevention of ovarian hyperstimulation syndrome"
(ovarian hyperstimulation syndrome = OHSS)
GnRH Antagonists—New Opportunities
The introduction of GnRH antagonists in controlled ovarian
hyperstimulation protocols (26, 27) has presented new
opportunities for novel stimulation protocols. A large (730
subjects) prospective randomized study (28 ) was carried out
to compare long GnRHa (buserelin) and GnRH antagonist
(ganirelix, orgalutran) protocols. The results suggest that
ganirelix introduces a new treatment option for patients
undergoing ovarian stimulation for IVF or intracytoplasmic
sperm injection that is safe, short, and simple. The clinical
outcome was good, and the ongoing pregnancy rate was
within the range of pregnancy rates of a long-protocol Gn-
RHa. This novel protocol also introduces new opportunities
in the context of OHSS prevention. One possibility is to
safely prevent spontaneous LH in high-risk patients with
high doses of GnRH antagonist, waiting patiently for follicular
demise and ovarian quiescence (29).
To effectively prevent OHSS, and to rescue the cycle at
the same time, the quick reversibility of the antagonistinduced
pituitary suppression can be advantageous by allowing
the use of GnRHa for the purpose of ovulation triggering.
This possibility has been assessed thus far in small-scale
published studies (30, 31). From these reports it can be
deduced that the pituitary response to GnRH or GnRHa is
preserved after GnRH antagonist–based follicular stimulation
protocols. The extent of pituitary gonadotropin suppression
depends on the dose used. Under the recommended
minimal effective dose of GnRH antagonists (0.25 mg
daily), it is most probable that ovulation could be safely and
effectively triggered with a GnRHa.
This may become a significant potential advantage of
GnRH antagonist–based controlled ovarian hyperstimulation
protocols for IVF because it allows the clinician to
choose the agent that will trigger ovulation. If OHSS is
imminent, ovulation may be triggered with a GnRHa, eliminating
any threat for significant OHSS.
GnRHa Ovulation Triggering in GnRH
Antagonist Stimulation Protocols
Prevents OHSS
This new treatment option for patients undergoing ovarian
stimulation was used to eliminate the risk of developing
OHSS in high responders. A preliminary report (32) describes
the use of 0.2 mg triptorelin (decapeptyl) to trigger
ovulation in eight patients who underwent controlled ovarian
hyperstimulation with recombinant FSH and concomitant
treatment with the GnRH antagonist ganirelix for the prevention
of premature LH surge. All patients were considered
to have an increased risk for developing OHSS (at least 20
follicles > 11 mm and/or serum E2 at least 3,000 pg/mL). On
the day of LH surge triggering, the mean number of follicles
> 11 mm was 25.1 + 4.5 and the median serum E2
concentration was 3,675 pg/mL (range, 2,980–7,670 pg/mL).
After GnRHa injection, endogenous serum LH and FSH surges
were observed with median peak values of 219 and 19 IU/L,
respectively, measured 4 hours after injection. The mean
number of oocytes obtained was 23.4 + 15.4, of which 83%
were mature (metaphase II). None of the patients developed
any signs or symptoms of OHSS. These preliminary results
clearly underline the effectiveness of this approach in OHSS
prevention.
Summary
The physiologic basis and clinical applications of the use
of GnRHa, rather than hCG, to induce the final stage of
oocyte maturation and ovulation in gonadotropin-treated cycles
were reviewed. A single midcycle dose of GnRHa is
able to trigger a preovulatory LH/FSH surge, leading to
oocyte maturation in women undergoing ovarian stimulation
for IVF or induction of ovulation in vivo. The main advantage
of this approach is the elimination of clinically significant
OHSS. The mechanism of action involves complete
quick and irreversible (even if pregnancy is achieved) luteolysis.
Luteolysis can also be achieved surgically once severe
OHSS has erupted (33), although it seems like a rather
awkward solution once we have a simple medical means to
achieve this same goal. Exogenous E2 and P supplementation
is necessary to compensate for the complete luteolysis.
This approach will probably become a major advantage
associated with the use of GnRH antagonists (rather than
GnRHa down-regulation) in ART protocols. Its correct application
is predicted to make severe OHSS a disease of the
past.
КЪСМЕТ, МИЛА !!! ylinfant
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Divna, ти започна ли вече? Дано този път стане! Стискам палци! :D
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Дони,благодаря ти :bighug: ! Сега се връщам от болницата,днес трябваше да е сондажа,но както винаги напоследък при мен- всяка заповед е предпоследна :? Пак промяна -връщаме се на предишния вариант с Декапептил депо.Пропускам и този месец,сондажа ще е след цикъла....и аз незнам какво да кажа вече....то затова и не пиша ,какви ще ги върша през зимата....
Пандичка благодаря и на теб,ти пак си стискай палците ,та дано започна през пролетта :bighug:
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Стискам и аз палците миличка. :P Дано всичко да стане по план.Успех, Яна :!:
(http://i.yoosms.com/i/uploaded/anim/1115200631130.gif)
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...днес трябваше да е сондажа,но както винаги напоследък при мен- всяка заповед е предпоследна :? Пак промяна -връщаме се на предишния вариант с Декапептил депо.Пропускам и този месец,сондажа ще е след цикъла....
8O :roll: А стига бе :!: :?: :!: